• Our case: Our patient is a 48 year old white male with history of Crohn's disease involving small intestine and colon. He was seen in ER for abscesses in the rectal region. A soft cystic mass was noted in the scrotum. Clear serous material discharge came out from from the penis. CT scan showed an abscess around rectum which extended into the penis, seminal vesicles and scrotum. A urethrogram revealed a fistulous tract extending into the scrotum. The patient was treated with antibiotics. A surgical repair of the fistula was recommended.

• Some patients develop ulceration of scrotum and/or spontaneous perineal urethral fistulae. Formation of a fistula extending from the anal canal to the root of scrotum and the penis may result in "watering can" appearance of scrotum during micturition, i.e. During urination, the urine comes out through openings in the scrotum.

• Depending on symptoms, the patient may first see their primary physician, a gastroenterologist or dermatologist. There may be gross swelling

and ulceration's of the scrotum and penis. Total involvement of the skin of the scrotum and penis may lead to the erroneous conclusion that it represents severe but transient edema caused by neighboring perianal abscesses and fistulae. Thickening of the prepuce may result in narrowing of the foreskin.

• The diagnosis is generally made by clinical features. Imaging studies including CT scan, gallium scan, ultrasound and magnetic resonance imaging may serve as valuable adjuncts. X-ray of urethra after filling it with a dye is diagnostic for urethral fistula. Differential diagnosis of the genitourinary lesions includes syphilis, herpes simplex, hidradenitis suppurativa, tuberculosis, actinomycosis, lymphogranuloma venereum, leishmaniasis, chancroid, Bechet's syndrome and filariasis.

• Treatment is controversial. Metronidazole and prednisone have been inconsistently shown to be of benefit. Azathioprine and 6-mercaptopurine are frequently used. Other treatments including diuretics, ascorbic acid or zinc supplements have been tried. Scrotal support may alleviate scrotal edema. Relapse may occur when medical treatment is withdrawn.

• Extensive genital cutaneous involvement may require incision and drainage of abscesses in the region as well as excision of the adjacent affected

bowel. Regular curettage and extensive excision of the perineal, penile and scrotal skin may be needed. Phimosis may require circumcision. Spontaneous healing of metastatic Crohn's disease ulcers has been reported.