Giant Scrotal Lymphoedema: A Case Series

Giant scrotal lymphoedema is a rare condition caused by obstruction, aplasia, or hypoplasia of lymphatic vessels draining the external genitalia. While this condition can be congenital or acquired, the most common acquired cause of such lymphatic obstruction worldwide is lymphatic filariasis (LF). We present a case series analysis of three patients of giant scrotal lymphoedema who were successfully treated for the condition in the Department of General Surgery, King George's Medical University (KGMU), Lucknow, with satisfactory post-operative recovery and minimal recurrence. The first patient was a 45-year-old who had been living with the condition for 10 years, and the resected scrotal tissue weighed 35 kg. The second patient was a 45-year-old who was diagnosed with filariasis five years back before the condition set in, and the resected scrotal tissue weighed 32 kg. The third patient was a 22-year-old young man who had been diagnosed with the condition 10 years back, and the resected scrotal tissue weighed 25 kg. Proper pre-operative evaluation was conducted in all three patients to establish the diagnosis of scrotal lymphoedema. The urethral catheterisation was conducted, which additionally helped to identify penile tissue intraoperatively. Careful exploration of scrotal tissue was conducted along with delineation of the penis from scrotal oedema. The surgical approach involved debulking scrotal lymphoedema with the reconstruction of scrotal skin while preserving penile tissue. Patients with giant scrotal lymphoedema face the social stigma that creates physical disability. Hence, they end up seeking medical help from tertiary care centres after the disease has reached advanced stages and fibrosis has set in. However, single-stage debulking, along with reconstructive surgery (referred to as reduction scrotoplasty), yields promising results even in cases of very bulky scrotal lymphoedema, weighing up to 35 kg, as per our study.