Surgical management of the giant scrotal lymphedema: A case report at a tertiary facility in northern Tanzania

Abstract

Introduction

Scrotal lymphedema is a chronic lymphatic disorder characterised by swelling of the scrotum due to lymphatic obstruction, often caused by filarial infection, malignancy, or inguinal surgery. This condition can lead to fibrosis, functional impairment, and recurrent infections. Treatment mainly involves surgical intervention. The presence of pan-urethral warts, as seen in this rare case, complicates management.

Case presentation

A 38-year-old Maasai man presented with chronic, massive penoscrotal lymphedema following childhood bilateral inguinal surgery. He developed a secondary infection, requiring surgical debridement and definitive scrotoplasty. Histology confirmed scrotal lymphedema without malignancy. Subsequently, excision of elephantoid skin and genital reconstruction was done and later on, the genital warts were excised and 5 % imiquimod cream was applied to clear the lesions. Postoperative recovery was uneventful, with good functional and cosmetic outcomes maintained at the six-month follow-up.

Clinical discussion

Genital lymphedema rarely occurs together with genital warts but may do so due to local immune impairment in lymphedematous skin. Diagnosis is primarily clinical, with histological confirmation of the findings. Management involves surgical excision. Delayed presentation for these patients extends the treatment and recovery period.

Conclusion

Scrotal lymphedema is characterised by an enlargement of the scrotum due to lymphatic obstruction, often linked to filariasis or surgery. It rarely occurs with genital warts, suggesting local immune compromise in such cases and requiring a combined approach of surgical and medical management.