This is a rare presentation of Filariasis affecting Retroperitonial region presented with Bilateral Groin Swelling treated by Laparoscopic and bilateral groin excision. Wuchereria bancrofti: the major parasite causing lymphatic filariasis. Hydrocele is the most common manifestation of chronic W. bancrofti infection in males, in endemic areas.
CASE REPORT: A 21-year old Nepali male admitted to our hospital in QATAR complaining of bilateral painless groin swelling. By examination, the patient looked healthy, afebrile, not pale, not jaundiced, no lymphadenopathies. Local examination revealed 10 X 8 cm soft swelling on the left groin (femoral triangle) and 6 X 4 cm same consistency swelling on the right side. The overlying skin where intact with no erythema, pigmentations, or dilated veins. The swellings were more prominent on standing while reduced on lying down. Non tender, partially compressible, no thrill or bruit over them, no lower limbs swelling.
The patient investigated by Ultrasound which revealed large lobulated soft swelling. CAT scan and MRI showed Retroperitonial infiltrative lesion, extending from the level of the renal hilum down to inguinal regions along the course of iliac vessels. Contrast study from the left groin swelling suggested the diagnosis of lymphangectasia while cytopathology of the aspirate which was bloody chyle showed microfilariae (Wuchereria bancrofti).
The patient underwent laparoscopic exploration using 3 trocars same as TAPP technique for hernia repair. Methylen blue injected in the groin swelling externally and showed clear boundaries of the stained lymphangectatic lesion by laparoscopy which facilitated preperitoneal dissection and excision of the lesion down to femoral canal, then followed by external incision in the groin to excise the external component of the lymphangectatic lesion. Histopathology of the excised specimen confirmed the diagnosis of filariasis and the patient was given anti-filarial medications.
In Conclusion, this is a rare case of retroperitoneal filariasis extending through the femoral canal to the groin treated by laparoscopic assisted excision and medications.
Program Number: P503