Lymphocele
| Lymphocele | |
|---|---|
 | |
| A CT scan of post-operative lymphocele | |
| Specialty | Surgery |
Alymphoceleis a collection oflymphatic fluidwithin the body not bordered byepithelial lining.[1]It is usually asurgical complicationseen after extensive pelvic surgery (such as cancer surgery) and is most commonly found in theretroperitoneal space.Spontaneous development is rare.[2]
Signs and symptoms
[edit]Many lymphoceles are asymptomatic. Larger lymphoceles may cause symptoms related to compression of adjacent structures leading to lower abdominal pain, abdominal fullness, constipation, urinary frequency, and edema of the genitals and/or legs. Serious sequelae could develop and include infection of the lymphocele, obstruction and infection of the urinary tract, intestinal obstruction, venous thrombosis, pulmonary embolism, chylous ascites and lymphatic fistula formation.[1] On clinical examination the skin may be reddened and swollen and a mass felt.UltrasonographyorCT scanwill help to establish a diagnosis. Other fluid collections to be considered in the differential diagnosis areurinoma,seroma,hematoma,as well as collections ofpus.Also, when lower limb edema is present,venous thrombosisneeds to be considered.[3]
Cause
[edit]The risk of the development of a lymphocele is positively correlated to the extent of the removal of lymphatic tissue during surgery (lymphadenectomy).[4]Surgery destroys and disrupts the normal channels of lymph flow. If the injury is minor, collateral channels will transport lymph fluid, but with extensive damage, fluid may accumulate in an anatomic space resulting in a lymphocele.[5]Typical operations leading to lymphocysts arerenal transplantationandradical pelvic surgerywith lymph node removal because of bladder, prostatic or gynecologic cancer.[6]Other factors that may predispose of lymphocele development are preoperativeradiation therapy,heparinprophylaxis (used to prevent deep vein thrombosis), and tumor characteristics.[1]After radical surgery for cervical and ovarian cancer studies with follow-up CT found lymphoceles in 20% and 32%, respectively.[7]Typically they develop within 4 months after surgery.[8]
Management
[edit]It has been suggested thatsuction drainsplaced during surgery and non-peritonisation (not closing the posterior peritoneum) may reduce the possibility of lymphocele development. Smaller lymphoceles can be managed expectantly, and many lesions will regress over time.[2]For symptomatic lesions a number of approaches are available and includefine needle aspirationwithultrasoundorcomputed tomographyguidance, catheter insertion and drainage (with possible use ofsclerosants), and surgical drainage.[2][6]Sex and masturbation may cause the lymphocele to grow if it is in the genital area. It is suggested to avoid these activities for around four to six weeks. Some exercises may also help to shrink it.
References
[edit]- ^abcMetcalf KS, Peel KR (1993)."Lymphocele".Annals of the Royal College of Surgeons of England.75(6): 387–392.PMC2498000.PMID8285540.
- ^abcde Oliveira Goes Junior AM, Haber Jeha SA (2012)."Idiopathic Lymphocele: A possible Diagnosis for Infraclavicular Masses".Case Reports in Surgery.2012:1–4.doi:10.1155/2012/593028.PMC3446650.PMID23008796.
- ^McCullough CS, Soper NJ (1991)."Laparoscopic drainage of a post transplant lymphocele".Transplantation.51(3): 725–7.doi:10.1097/00007890-199103000-00034.PMID2006532.
- ^Mori N (1955). "Clinical and experimental studies on so called lymphocyst which develops after radical hysterectomy in cancer of the uterine cervix".J Jpn Obstet Gynecol Soc.2(2): 178–203.PMID13286539.
- ^White M, Mueller PR, Ferrucci JT, et al. (1985)."Percutaneous drainage of postoperative abdominal and pelvic lymphoceles".American Journal of Roentgenology.145(5): 1065–1069.doi:10.2214/ajr.145.5.1065.PMID3901705.
- ^abKim JK, Jeong YY, Kim YH, Kim YC, Kang HK, Choi HS (1999). "Postoperative Pelvic Lymphocele: Treatment with Simple Percutaneous Catheter Drainage".Radiology.212(2): 390–94.doi:10.1148/radiology.212.2.r99au12390.PMID10429695.
- ^Petru E, Tamussino K, Lahousen M, Winter R, Pickel H, Haas J (1989). "Pelvic and paraaortic lymphocysts after radical surgery because of cervical and ovarian cancer".Am J Obstet Gynecol.161(4): 937–41.doi:10.1016/0002-9378(89)90757-6.PMID2801842.
- ^Cantrell CJ, Wilkinson EJ (1983). "Recurrent squamous cell carcinoma of the cervix within pelvic-abdominal lymphocysts".Obstet Gynecol.62(4): 530–4.PMID6888835.