Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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270 Surgery and Healing in the Developing World
Scrotal Elephantiasis (Figs. 60-63)
This problem may come from chronic filariasis. It is also present with chronic
infections of the scrotum. Included with this is the ‘water pot’ perineum associated
with gonococcal urethritis and stricture.
Have at least two units of blood available. The operation can be done after one
week of careful skin preparation, which includes potassium permanganate soaks
and twice a day sitz baths. Spinal anesthesia with the patient in a supine position
works well. Calibrate the urethra with a urethral sound. Pass a catheter into the
bladder. Apply a tourniquet, a #30 catheter, at the base of the scrotum and penis.
The blood loss can be astounding. Make planned skin flaps on the adjacent normal
skin for use in reconstructing the shaft of the penis as well as a cover for the testicles.
Make the skin incision that will remove all the diseased edematous and diseased
skin. Rescue the testicles and lay them on the abdominal wall. Remove the remaining
mass with care to the urethra. The urethra has been protected and identified
with the urethral catheter already. Make a continuous suture of interlocking 2-0
vicryl in the pattern of an ‘H’ in the deep perineum. This will ligate the many large
vessels, which have supplied blood to the large elephantiasis mass. This ‘H’ will be
on each side of the urethra, beneath the urethra, and extending down on each side
toward the rectum.
Figure 57. Giant elephantiasis of scrotum.
Figure 58. After resection of elephantiasis of
scrotum.