Diagnostic Challenges in Donor Studies: A Case of Buried Penis Secondary to Giant Inguinoscrotal Hernia and Scrotal Lymphedema

2LT Dominique Zarrella; 2LT David Holovac; 2d Lt Jordyn Albert; 2d Lt Julia Asada; ENS Olivia Staser; Maria Ximena Leighton; Jordan Dimitrakoff; Lynette Parker; Barbara Knollmann-Ritschel; Joanne Lenert; Kerrie Lashley; Rodrigo Mateo; Teresa Buescher; Guinevere Granite

doi:10.61797/ijcsav.v5i2.370

2LT Dominique Zarrella F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
2LT David Holovac F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
2d Lt Jordyn Albert F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
2d Lt Julia Asada F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
ENS Olivia Staser F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
Maria Ximena Leighton Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
Jordan Dimitrakoff Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
Lynette Parker Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
Barbara Knollmann-Ritschel Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
Joanne Lenert The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20814, USA
Kerrie Lashley The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20814, USA
Rodrigo Mateo Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
Teresa Buescher The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20814, USA
Guinevere Granite Director of Human Anatomy, Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, A3020C, Bethesda, MD 20814, USA https://orcid.org/0000-0003-3953-2250

DOI: https://doi.org/10.61797/ijcsav.v5i2.370

Keywords: Hidden penis, Hidden penis syndrome, Buried penis, Buried penis syndrome, Giant indirect inguinoscrotal hernia

Abstract

Buried or hidden penis, also known as buried or hidden penis syndrome, is a condition where the penis is normal in size, but concealed beneath the abdomen, thigh, or scrotum. Seen in children due to congenital abnormalities, post-circumcision scarring, or obesity, buried penis in adults is less well-defined and often linked to obesity, prior surgical history, or lymphedema. Diagnosis is primarily clinical and relies heavily on detailed patient history and thorough physical examination, which is unattainable when studying a donor.

We report a case of an 86-year-old male donor whose penis was not externally visible as it was buried inside dilated scrotal sac secondary to lymphedema in the setting of a giant indirect inguinoscrotal hernia. Given our findings, we hypothesize that tension created by the hernia pulling on the skin, as demonstrated by scrotal sac dilation combined with subsequent/concurrent lymphedema, likely contributed to what appeared to be a buried penis. However, the lack of accessible information on this cadaver, including a detailed past medical and surgical history, limits the certainty of a buried penis diagnosis in this context.

This case is unique in exploring the possible relationship between a giant inguinoscrotal hernia and a buried penis but without the detailed patient history typically required for a definitive buried penis diagnosis. Our findings highlight the limitations of diagnosing a buried penis in donor studies and suggest that anatomical changes other than the previously well-defined historical criteria should be considered as likely contributors to adult-acquired buried penis.