Abdominal Elephantiasis—End Stage Disease or Treatable Disorder? Case Report, Surgical Technique and Review of the Literature

Abdominal elephantiasis (AE) is a rare, deforming and chronical skin disease related to massive obesity. Up to date, there are only 16 cases described in the literature, but the disease is definitely underreported. AE is caused by chronic terminal dysfunction of the lymphatic system and recurrent infections of the abdominal soft tissues. Lipectomy could be a suitable treatment, but the comorbidities of the patients and the high risk of intraoperative and postoperative complications make the surgery complex and poorly adopted. Accordingly, only two procedures are reported in the literature. The Bipolar Radiofrequency Scalpel (BRS) ability to lower bleeding, shorten haemostasis surgical time, reduce pain and postoperative complications could make lipectomy safer and achievable in a larger population. This article presents the authors’ experience on BRS-assisted lipectomy for AE. A 70-year-old, morbidly obese man, weighing 180 kg, BMI 51, presented an adipocutaneous apron extended to the knees, which was diagnosed as AE. The patient complained of a progressive worsening of the quality of life and considerable limitations in mobility. Surgical suitability has been assessed by a multidisciplinary team. He underwent BRS-assisted abdominal lipectomy. No intraoperative or postoperative complications were found. Recovery was uneventful with significant improvement in patient’s mobility and quality of life. Chronic lymphedema in obese patients can lead to AE, thus involving progressive, extreme skin deformation. BRS-assisted lipectomy appears to be an eligible treatment of selected cases of AE.