Refractory Lymphatic Fistula after Pancreaticoduodenectomy Treated by Percutaneous Transhepatic Lymphography

Abstract

Lymphorrhea is a relatively rare postoperative complication. We report a case of a 78-year-old man who experienced refractory lymphorrhea after pancreaticoduodenectomy with D2 lymph node dissection for pancreatic cancer. Fasting treatment with total parenteral nutrition and subcutaneous injection of octreotide were not effective. We performed percutaneous lymphography using lipiodol from the bilateral inguinal lymphatic vessels because we first took into account the possibility of lymphorrhea due to para-aortic lymph node sampling. However, the lymphorrhea could not be cured. Furthermore, we performed percutaneous transhepatic lymphography (PTL) by using lipiodol because we considered the possibility of lymphorrhea due to lymph node dissection in the hepatoduodenal ligament. Leakage of the lipiodol around the choledochojejunostomy was observed and lymphorrhea was cured completely 5 days after PTL. PTL is considered to be an effective treatment method for intractable lymphorrhea after pancreatic cancer surgery.