Lymphocele

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Lymphocele
Specialty Surgery

A lymphocele is a collection of lymphatic fluid within the body not bordered by epithelial lining. [1] It is usually a surgical complication seen after extensive pelvic surgery (such as cancer surgery) and is most commonly found in the retroperitoneal space. Spontaneous development is rare. [2]

Contents

Signs and symptoms

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. Ultrasonography or CT scan will help to establish a diagnosis. Other fluid collections to be considered in the differential diagnosis are urinoma, seroma, hematoma, as well as collections of pus. Also, when lower limb edema is present, venous thrombosis needs to be considered. [3]

Cause

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 are renal transplantation and radical pelvic surgery with lymph node removal because of bladder, prostatic or gynecologic cancer. [6] Other factors that may predispose of lymphocele development are preoperative radiation therapy, heparin prophylaxis (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

It has been suggested that suction drains placed 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 include fine needle aspiration with ultrasound or computed tomography guidance, catheter insertion and drainage (with possible use of sclerosants), 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.

Related Research Articles

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Lymphedema, also known as lymphoedema and lymphatic edema, is a condition of localized swelling caused by a compromised lymphatic system. The lymphatic system functions as a critical portion of the body's immune system and returns interstitial fluid to the bloodstream. Lymphedema is most frequently a complication of cancer treatment or parasitic infections, but it can also be seen in a number of genetic disorders. Though incurable and progressive, a number of treatments may improve symptoms. Tissues with lymphedema are at high risk of infection because the lymphatic system has been compromised.

<span class="mw-page-title-main">Edema</span> Accumulation of excess fluid in body tissue

Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels tight, the area may feel heavy, and joint stiffness. Other symptoms depend on the underlying cause.

<span class="mw-page-title-main">Ureter</span> Tubes used in the urinary system in most animals

The ureters are tubes made of smooth muscle that propel urine from the kidneys to the urinary bladder. In a human adult, the ureters are usually 20–30 cm (8–12 in) long and around 3–4 mm (0.12–0.16 in) in diameter. The ureter is lined by urothelial cells, a type of transitional epithelium, and has an additional smooth muscle layer that assists with peristalsis in its lowest third.

<span class="mw-page-title-main">Hysterectomy</span> Surgical removal of the uterus

Hysterectomy is the surgical removal of the uterus and cervix. Supracervical hysterectomy refers to removal of the uterus while the cervix is spared. These procedures may also involve removal of the ovaries (oophorectomy), fallopian tubes (salpingectomy), and other surrounding structures. The term “partial” or “total” hysterectomy are lay-terms that incorrectly describe the addition or omission of oophorectomy at the time of hysterectomy. These procedures are usually performed by a gynecologist. Removal of the uterus renders the patient unable to bear children and has surgical risks as well as long-term effects, so the surgery is normally recommended only when other treatment options are not available or have failed. It is the second most commonly performed gynecological surgical procedure, after cesarean section, in the United States. Nearly 68 percent were performed for conditions such as endometriosis, irregular bleeding, and uterine fibroids. It is expected that the frequency of hysterectomies for non-malignant indications will continue to fall given the development of alternative treatment options.

<span class="mw-page-title-main">Urinary retention</span> Inability to completely empty the bladder

Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When of sudden onset, symptoms include an inability to urinate and lower abdominal pain. When of gradual onset, symptoms may include loss of bladder control, mild lower abdominal pain, and a weak urine stream. Those with long-term problems are at risk of urinary tract infections.

<span class="mw-page-title-main">Cystectomy</span> Surgical removal of all or part of the bladder

Cystectomy is a medical term for surgical removal of all or part of the urinary bladder. It may also be rarely used to refer to the removal of a cyst. The most common condition warranting removal of the urinary bladder is bladder cancer.

<span class="mw-page-title-main">Chylothorax</span> Medical condition

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<span class="mw-page-title-main">Pelvic exenteration</span> Surgical removal of all pelvic organs

Pelvic exenteration is a radical surgical treatment that removes all organs from a person's pelvic cavity. It is used to treat certain advanced or recurrent cancers. The urinary bladder, urethra, rectum, and anus are removed. In women, the vagina, cervix, uterus, Fallopian tubes, ovaries and, in some cases, the vulva are removed. In men, the prostate is removed. The procedure leaves the person with a permanent colostomy and urinary diversion.

<span class="mw-page-title-main">Nephrostomy</span> Surgical procedure that creates a long-term opening between the kidney and the skin

A nephrostomy or percutaneous nephrostomy is an artificial opening created between the kidney and the skin which allows for the urinary diversion directly from the upper part of the urinary system. It is an interventional radiology/surgical procedure in which the renal pelvis is punctured whilst using imaging as guidance. Images are obtained once an antegrade pyelogram, with a fine needle, has been performed. A nephrostomy tube may then be placed to allow drainage.

<span class="mw-page-title-main">Radical retropubic prostatectomy</span>

Radical retropubic prostatectomy is a surgical procedure in which the prostate gland is removed through an incision in the abdomen. It is most often used to treat individuals who have early prostate cancer. Radical retropubic prostatectomy can be performed under general, spinal, or epidural anesthesia and requires blood transfusion less than one-fifth of the time. Radical retropubic prostatectomy is associated with complications such as urinary incontinence and impotence, but these outcomes are related to a combination of individual patient anatomy, surgical technique, and the experience and skill of the surgeon.

<span class="mw-page-title-main">Pampiniform plexus</span> Vein network in human males

The pampiniform plexus is a venous plexus – a network of many small veins found in the human male spermatic cord, and the suspensory ligament of the ovary. In the male, it is formed by the union of multiple testicular veins from the back of the testis and tributaries from the epididymis.

<span class="mw-page-title-main">Fallopian tube obstruction</span> Medical condition

Fallopian tube obstruction, also known as fallopian tube occlusion is a major cause of female infertility. Blocked fallopian tubes are unable to let the ovum and the sperm converge, thus making fertilization impossible. Fallopian tubes are also known as oviducts, uterine tubes, and salpinges.

<span class="mw-page-title-main">Ovarian vein syndrome</span> Medical condition

Ovarian vein syndrome is a rare condition in which a dilated ovarian vein compresses the ureter. This causes chronic or colicky abdominal pain, back pain and/or pelvic pain. The pain can worsen on lying down or between ovulation and menstruation. There can also be an increased tendency towards urinary tract infection or pyelonephritis. The right ovarian vein is most commonly involved, although the disease can be left-sided or affect both sides. It is currently classified as a form of pelvic congestion syndrome.

Primary fallopian tube cancer (PFTC), often just tubal cancer, is a malignant neoplasm that originates from the fallopian tube.

Neuroendocrine carcinoma of the cervix is best defined separately:Neuroendocrine: Of, relating to, or involving the interaction between the nervous system and the hormones of the endocrine glands.Carcinoma: An invasive malignant tumor derived from epithelial tissue that tends to metastasize to other areas of the body.

Septic thrombophlebitis refers to venous thrombosis and inflammation associated with bacteremia.

<span class="mw-page-title-main">Pelvic congestion syndrome</span> Medical condition

Pelvic congestion syndrome, also known as pelvic vein incompetence, is a long-term condition believed to be due to enlarged veins in the lower abdomen. The condition may cause chronic pain, such as a constant dull ache, which can be worsened by standing or sex. Pain in the legs or lower back may also occur.

<span class="mw-page-title-main">Uterine incarceration</span> Medical condition

Uterine incarceration is an obstetrical complication whereby a growing retroverted uterus becomes wedged into the pelvis after the first trimester of pregnancy.

<span class="mw-page-title-main">Wertheim–Meigs operation</span>

The Wertheim–Meigs operation is a surgical procedure for the treatment of cervical cancer performed by way of an abdominal incision.

Pelvic compression syndrome is characterized by an intermittent or persisting pain in the abdomen, which is exacerbated by abdominal pressure. It is caused by a swelling of the veins in the valveless pampiniform plexus.

References

  1. 1 2 3 Metcalf KS, Peel KR (1993). "Lymphocele". Annals of the Royal College of Surgeons of England. 75 (6): 387–392. PMC   2498000 . PMID   8285540.
  2. 1 2 3 de 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 . PMC   3446650 . PMID   23008796.
  3. ↑ McCullough CS, Soper NJ (1991). "Laparoscopic drainage of a post transplant lymphocele". Transplantation. 51 (3): 725–7. doi: 10.1097/00007890-199103000-00034 . PMID   2006532.
  4. ↑ 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. PMID   13286539.
  5. ↑ 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 . PMID   3901705.
  6. 1 2 Kim 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. PMID   10429695.
  7. ↑ 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. PMID   2801842.
  8. ↑ Cantrell CJ, Wilkinson EJ (1983). "Recurrent squamous cell carcinoma of the cervix within pelvic-abdominal lymphocysts". Obstet Gynecol. 62 (4): 530–4. PMID   6888835.
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