Idiopathic Scrotal Elephantiasis in a Non-Endemic Area: Successful Surgical Management

Giant scrotal lymphedema, also known as elephantiasis, typically develops due to lymphatic vessel obstruction, aplasia, or hypoplasia. While most cases are secondary to infectious causes such as filariasis or lymphogranuloma venereum in tropical and subtropical regions, idiopathic cases are rare in non-endemic areas. This condition affects the scrotum and penis. A 37-year-old male presented with a 2-year history of painless scrotal swelling and skin redness. Examination revealed a massively enlarged, fibrotic scrotum (20×22×18 cm) with non-palpable testes, along with associated psychological and functional impairments. Imaging showed bilateral scrotal lymphedema with hydroceles. After failed conservative treatment, the patient underwent scrotoplasty and hydrocelectomy. Postoperative recovery was uneventful, and the patient reported improvement in physical, psychological, and hygienic well-being. This case highlights a rare instance of idiopathic scrotal elephantiasis outside endemic regions, emphasizing the importance of considering idiopathic etiology in non-tropical settings and the role of surgical reconstruction for satisfactory outcomes.