Lymphoedema of the limbs: an experience from a tertiary clinic in the central province of Sri Lanka

Abstract

Objective A descriptive study to evaluate the pattern of presentation of lymphoedema of limbs to a tertiary care clinic in the central province of Sri Lanka. Patients and Method Patients with lymphoedema seen over 28 years, (1980-2007) in the vascular clinic at the General Hospital Peradeniya were reviewed retrospectively. Results 649 cases of lymphoedema of limbs were seen. 47 were in the upper limb, 36 of whom were secondary, mostly following axillary clearance associated with a mastectomy, and 11 cases were idiopathic. 602 patients had their lower limbs involved, with 96 cases amongst them being secondary, mostly to trauma, filariasis and a few with pelvic carcinoma and lymphoma. The rest (n =506) were considered to have lymphoedema of primary aetiology. The involvement of the legs was predominantly below the knees. A late onset group of lymphoedema patients, predominantly males above 60 years posed a problem in diagnosis and is worth future study. Complications among patients with lymphoedema of lower limbs with no overt secondary cause included inter digital cleft sepsis in 54.5 %, cellulitis or a history of the same in 66 %, lymphangitis 16 % lymphadenitis 3.5% and 11 % had septicaemia which aggravated the clinical state. Conclusion Primary lymphoedema needs recognition as the dominant cause of limb lymphoedema especially in the Central Province. This diagnosis is required to prevent complications which need long term treatment. A filarial aetiology for most cases, as is popularly believed, is not evidence based. Secondary causes for lower limb lymphoedema must be looked for, such as pelvic malignancy and lymphoma. Trauma or surgery over lymphatic pathways should be avoided to prevent limb lympheodema.