28-Year-Old Man Experiencing Swelling in the Scrotal Area
I'm reaching out in what feels like a desperate plea, and I truly apologize for sharing such an intimate matter. My husband's scrotum has been experiencing swelling since December 2023. We managed to consult a physician by January 2024. Since that initial appointment, we have undergone several evaluations, including: - an ultrasound - a comprehensive CT scan from chest to pelvis - extensive blood tests - and various other routine examinations. Despite these efforts, there have been no indications of abnormality; there is simply no explanation. The swelling fluctuates; at times it decreases, but it never fully returns to its previous state. So far, the only treatment providing him any relief has been corticosteroids. Additionally, he has noticed some swelling in the penile area as well. We’ve purchased supportive jockstraps and boxer briefs designed with mesh to provide extra support for his scrotum. He has to use ice frequently, as this has a significant impact on his daily life, and I'm at a loss regarding the next steps. He has also mentioned that the area between his genitals and rear seems bumpy and irritated, and he often feels sweaty in that region. We have consulted both his primary care physician and a urologist for assistance. It's worth noting that he has a background of eczema and psoriasis on his elbows and shins. I kindly ask for any guidance or advice you may have.
Answers (1)
6/21/2025, 5:40:34 PM
OpenHealth AI
I'm sorry to hear about your husband's ongoing struggles with swelling in his scrotal area. It sounds like you both have taken significant steps to understand and manage his condition, and I commend you for your proactive approach.
Main Points: The persistent swelling could stem from various factors, including inflammation, fluid accumulation, or even a response to his skin conditions like eczema and psoriasis. Since multiple evaluations have not revealed clear abnormalities, it’s important to focus on symptom management and modifications in care.
Explanation: Swelling in the scrotal area can be caused by several issues, including inflammation, infections, or even conditions related to skin problems like eczema. The fluctuating nature of the swelling, along with the response to corticosteroids, suggests that there may be an inflammatory component. The bumpy and irritated area between the genitals and the rear may also indicate a possible skin condition or irritation related to moisture and friction. Additionally, excessive sweating can exacerbate skin irritation, leading to further discomfort.
Next Steps:
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Symptom Management:
- Continue using ice packs to manage swelling, ensuring there’s a barrier (like a cloth) to prevent skin damage.
- Keep using supportive jockstraps and breathable boxer briefs to minimize friction and sweating. Consider moisture-wicking fabrics which can help with sweat management.
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Moisture Control:
- Apply antifungal powder or moisture-absorbing powder (like talcum powder or specialized body powders) to reduce moisture and irritation in the area. This can also help if fungal infections are a concern due to the heat and sweat.
-
Skin Care:
- Investigate the use of a gentle, fragrance-free cleanser for the genital area to reduce irritation from soaps and products that may exacerbate his eczema or psoriasis.
- Consider discussing with his physician the possibility of using a topical steroid or anti-inflammatory cream specifically designed for sensitive areas if skin irritation increases.
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Monitor Symptoms:
- Keep a symptom diary detailing when the swelling increases or decreases, what activities may influence these changes, and any new symptoms that arise. This can help the healthcare team in managing and understanding his condition better over time.
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Follow-Up on Skincare:
- Since he has a history of eczema and psoriasis, consulting a dermatologist may provide new insights or treatment options. They can help tailor a skin care regime that minimizes irritation while addressing both the scrotal area and the bumps experienced.
Your husband’s well-being is the priority, and while this situation may feel overwhelming, you are taking important steps. Continue collaborating with his healthcare team, and don't hesitate to seek further consultations or referrals if needed. Please feel free to reach out if you have more questions or need further clarifications.
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Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.