17-year-old boy with primary elephantiasis treated

Primary lymphedema is rare, affecting 1 in 1,00,000 individuals. Secondary lymphedema is the most common cause of the disease and affects approximately 1 in 1,000 individuals.

A team headed by Dr. Nilesh Satbhai, Consultant Plastic and Reconstructive Microsurgeon, Bai Jerbai Wadia Hospital For Children AT Parel in Mumbai, successfully treated a 17-year-old boy with Primary Lymphoedema.

The boy who had massive swelling over the entire lower limbs and was bed-ridden can move freely now.

Lymphoedema is a chronic condition that causes swelling in the body tissues. It can affect any part of the body but usually develops in the arms or legs. It develops when the lymphatic system does not work properly and the patient becomes immobile and is left untreated.

Puraw Vira, a resident of Mumbai started developing swelling over both his feet and ankles when he was 8.

His parents consulted several doctors, but could not find any solution to his problem. This swelling gradually progressed to the legs, thighs, and later the groin as well. He couldn’t do his daily activity with ease. With time the legs progressively became very bulky and heavy.

Photo Credit: Bai Jerbai Wadia Hospital, Mumbai

The child would develop intermittent infections over the legs requiring repeated hospital admissions. He was bed-ridden in April 2021, for over a month and his basic activities were restricted to a major extent, and required assistance from his family members. The patient was referred to the Plastic Surgery department at Bai Jerbai Wadia Hospital for Children wherein he could stand on his feet again after prompt treatment.

Dr. Nilesh Satbhai, Consultant Plastic, and Reconstructive Microsurgeon said, “The patient arrived with a history of swelling in both lower limbs and groin, and was bed-ridden. He was diagnosed to have primary lymphoedema, commonly known as elephantiasis. It is a clinical diagnosis.”

Dr. Satbhai added,” Puraw was advised to undergo surgery for the treatment of lymphedema. After optimal preoperative preparation, he underwent vascularized lymph node transfers (VLNT) for both the lower limbs. VLNT is an advanced microvascular procedure, in which a few normal lymph nodes are taken from a distant part (such as the neck, chest, abdomen, etc.) and they are implanted into the limb affected by lymphedema.

"These transferred lymph nodes then help to drain the excess fluid from the limb and reduce the limb swelling. The surgery lasted for 6 hours. The boy was discharged after 10 days. He recovered well after the microvascular surgery on both lower limbs and the swelling on both his legs reduced significantly. The surgery has helped the boy to become mobile, playful, and active again. The parents are advised to perform a special type of massage called ‘manual lymphatic drainage. The parents are relieved, as the child is no longer dependent on them for his basic hygiene and personal activities.”