Surgical Management of Large Refractory Scrotal Wall Edema in a Child with Nephrotic Syndrome: A Rare Pediatric Emergency

Abstract

Scrotal edema is a known manifestation of generalized edema in nephrotic syndrome (NS), typically resolving with medical therapy. However, refractory scrotal wall edema requiring surgical intervention is exceptionally rare. We present the case of a 7-year-old male with frequently relapsing, steroid-dependent nephrotic syndrome who developed severe scrotal wall edema unresponsive to diuretics and steroids. Surgical consultation was sought, and a preliminary diagnosis of hydrocele was made. However, ultrasound revealed diffuse, non-encapsulated scrotal wall edema. Due to increasing discomfort and signs of inflammation, surgical drainage was performed using multiple scrotal punctures and glove drain placement. Postoperatively, edema resolved completely. This case emphasizes the importance of timely differentiation between hydrocele and scrotal wall edema in NS, and highlights a rare but significant indication for surgical intervention in pediatric NS. Early imaging and multidisciplinary management are key to preventing complications like Fournier’s gangrene. To the best of our knowledge, this is the first reported case of refractory scrotal wall edema in NS requiring surgical management.

Keywords: Scrotal edema, nephrotic syndrome, Large Refractory