Refractory Hepatic Lymphorrhea Successfully Treated by Percutaneous Transhepatic Lymphography and Intraperitoneal Administration of OK-432 Following Pancreaticoduodenectomy for Intraductal Papillary Mucinous Neoplasm of the Pancreas

Abstract

Lymphorrhea following gastrointestinal surgery may sometimes cause malnutrition and decreased immunity, and may become serious if not rapidly treated. We treated a patient in whom refractory lymphorrhea following pancreaticoduodenectomy (PD) was diagnosed as hepatic lymphorrhea. Conservative therapy with continuous subcutaneous octreotide and continuous intravenous etilefrine was initially provided, but the patient failed to improve and deteriorated to the pre-shock state. Percutaneous transhepatic lymphography (PTL) was performed with the aim of direct occlusion of the hepatic lymphorrhea, and the amount of lymph leakage was reduced by half. Selective OK-432 was then administered intraperitoneally, resulting in complete response. Rather than presenting this as a case report on the use of PTL and intraperitoneal OK-432 for treatment of lymphorrhea following PD, we consider this method to be an effective therapeutic option for cases of postoperative refractory hepatic lymphorrhea.