article · International Journal of Surgery Case Reports
Congenital conditions such as clitoromegaly present substantial healthcare hurdles in resource-limited environments due to shortages in specialised surgical expertise. This report describes the management of a three-year-old girl with clitoromegaly linked to suspected congenital adrenal hyperplasia with a 46XX karyotype. Diagnostic laparoscopy confirmed normal female internal anatomy, while parental worries focused on long-term psychological wellbeing. Visiting paediatric surgeons recommended and successfully carried out a subtunical reduction clitoroplasty alongside labial reconstruction and vaginoplasty. This advanced reconstructive method preserves crucial neurovascular function while addressing anatomical appearance. The collaborative intervention achieved positive aesthetic and functional results despite local infrastructure limitations. Ultimately, the intervention demonstrates how international clinical partnerships can facilitate complex paediatric reconstructions and manage delicate ethical considerations in low-resource contexts, although ongoing assessment of long-term patient outcomes remains necessary.
Treating rare congenital conditions in under-resourced settings is often constrained by a lack of advanced surgical training and facilities. Demonstrating that complex, nerve-sparing reconstructive techniques can be completed safely through international partnerships provides a pathway for improving paediatric surgical care globally, helping ensure that young patients obtain appropriate functional, aesthetic, and psychosocial care regardless of geography.
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BACKGROUND: Congenital anomalies, including clitoromegaly, are significant challenges, particularly in resource-limited settings where access to specialized care may be lacking. Clitoral enlargement is often associated with disorders of sexual differentiation, such as congenital adrenal hyperplasia. Managing such conditions in under-resourced environments requires specialized surgical expertise and collaborative approach. CASE PRESENTATION: A 3-year-old girl from a resource-limited community was referred for management of clitoromegaly diagnosed since birth. Hormonal assays showed slightly elevated 17-hydroxyprogesterone, suggesting congenital adrenal hyperplasia with a 46XX karyotype. A diagnostic laparoscopy was performed, confirming normal female internal structures. Her parents were concerned about psychological implications. Subtunical clitoroplasty, an advanced reconstructive procedure preserving neurovascular function with labial reconstruction and vaginoplasty were recommended by visiting pediatric surgeons to restore a more typical anatomical appearance. DISCUSSION: The subtunical clitoroplasty was successfully performed, achieving favorable aesthetic and functional outcomes. The involvement of global health surgeons from a developed country facilitated the application of advanced techniques despite local resource constraints. This case emphasizes the value of global health collaborations in providing high-quality care in resource-limited settings. Ethical considerations, including the child's future autonomy and the psychological impact of surgery, were carefully addressed with the family. CONCLUSION: This case highlights the successful surgical management of clitoromegaly in a child from a resource-limited setting through subtunical clitoroplasty. It underscores the importance of international collaboration in advancing pediatric genital reconstruction and the need for ongoing support for both medical and psychosocial outcomes in such cases. Further research is needed to evaluate long-term outcomes in similar settings.
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DOI: 10.1016/j.ijscr.2025.111415
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