~ 13 ~ International Journal of Surgery Science 2019; 3(3): 13-16 E-ISSN: 2616-3470 P-ISSN: 2616-3462 © Surgery Science www.surgeryscience.com 2019; 3(3): 13-16 Received: 09-05-2019 Accepted: 13-06-2019 Dr. Chandrakala Kumari PG Std, Department of Surgery, Nalanda Medical College and Hospital, Patna, Bihar, India Dr. Manawor Ahsan Assistant Professor, Department of Surgery, Nalanda Medical College and Hospital, Patna, Bihar, India Dr. Syed Nazir Hussain Associate Professor, Department of Surgery, Nalanda Medical College and Hospital, Patna, Bihar, India Dr. Raj Shekhar Senior Residence, Department of Surgery, Nalanda Medical College and Hospital, Patna, Bihar, India Dr. Ranvijay Bharti PG Std, Department of Surgery, Nalanda Medical College and Hospital, Patna, Bihar, India Dr. Brajesh Kumar PG Std, Department of Surgery, Nalanda Medical College and Hospital, Patna, Bihar, India Correspondence Dr. Chandrakala Kumari PG Std, Department of Surgery, Nalanda Medical College and Hospital, Patna, Bihar, India Unusual presentation of filarial scrotal tumor and its management Dr. Chandrakala Kumari, Dr. Manawor Ahsan, Dr. Syed Nazir Hussain, Dr. Raj Shekhar, Dr. Ranvijay Bharti and Dr. Brajesh Kumar DOI: https://doi.org/10.33545/surgery.2019.v3.i3a.04 Abstract Background: Filarial Scrotal Tumor (FST) is endemic regions in country like Asia and Africa. It is of variable origin in the country like India. Case presentation: We present a case of a 50-year-old male with huge scrotal swelling lead to chronic inflammation lesion of affected part. The patient underwent subtotal scrotectomy saving penis, testes and spermatic cords and followed by scrotal reconstruction with adequate cosmetic and functional outcome. Conclusion: In this report we discuss a rare case of scrotal filariasis in a patient, reflect on the etiology and the diagnostic and therapeutic approaches. Surgery can be successful even in giant filarial scrotum tumor. Keywords: Filarial scrotal tumor (FST), scrotoplasty, penoplasty Introduction Massive scrotal swelling caused by obstruction, aplasia or hypoplasia of lymphatic vessels. It is usually caused by acquired infection e.g. lymphogranuloma venereum or filarial infestation with Wuchereria bancrofti. Filarial Scrotal Tumor (FST) is variable present in India [1, 2] . Occasionally it has been attributed to radiotherapy, neoplasm and lymphadenectomy [3, 4] . Primary lymphedema i.e. congenital elephantiasis, is an extremely rare condition. Patients develop edema at adolescence without restriction to the external genitalia. In hereditary elephantiasis of the Meige type, lymphedema of the external genitalia occurs due to malformation of lymphatic vessels [4] . In some cases hidradenitis suppurativa and lichen sclerosus et atrophicus have also been described [5] . Scrotal elephantiasis is both emotionally distressing and physically disabling. Difficulties with hygiene, urinary incontinence, loss of libido and immobility are severely debilitating symptoms. The etiology of the lymphedema usually determines the natural course and the therapeutic approach. Case presentation Case report Fifty years male from Baheri, Darbhanga had chief complain of huge scrotal swelling of size 30*20*8 cm for last 10 years. Swelling was progressive with discharging ulcer from left side of scrotum since 3 years. Patient was symptom free 10 years back. He develop scrotal swelling on left side for which eversion of sac done. However develop ulcer on operated side. Later on he gradually develop swelling whole of scrotum. Taken medication for that but not relief. Thus he came to Nalanda Medical College and Hospital, Patna, surgery OPD for further management. He has past Surgical history of operation for left Sided hydrocele 8 yrs back for which eversion of sac was done. Operated for fracture right tibia 3 yrs back for which tibia interlocking was done. There was no past medical history of HTN, DM, TB, COPD or any other chronic illness. General examination Patient is conscious, co-operative well oriented with time, place and person. Pallor present. No icterus, clubbing, cyanosis. CNS, CVS, Resp. system was in normal limits. On examination, the patient had a massively enlarged scrotum extending upto his knees. The huge solid scrotal mass of 30*20*8 cm made it impossible to differentiate the anatomic structures (Figure 1) and the urethral orifice not appreciated.