Dilatation of the Lymphatic Vessels at the Porta Hepatis Following Gastrectomy for Gastric Cancer

Abstract

Lymph node dissection of the hepatoduodenal ligament interrupts the main lymphatic drainage of the liver. This interruption usually causes no trouble clinically, but we report a rare case of dilatation of the lymphatic vessels at the porta hepatis following gastrectomy for gastric cancer. The patient was a 58-year-old man who had undergone distal gastrectomy with R2 + No12 lymph node dissection and cholecystectomy for gastric cancer. A large amount of ascitic fluid developed after the operation, but the ascites was treated successfully with conservative treatment. Six months after the operation he was readmitted because of epigastric fullness. Ultrasonography showed anechoic areas around the left branch of the portal vein. Fluid aspirated from the anechoic areas was clear, serous and yellowish. It had a high protein content and almost the same electrolyte concentration as the serum. The retention fluid consisted of the lymph of the liver. Introduction of contrast material into the retention cavity revealed vessel-like structures with constriction. The patient recovered after percutaneous transhepatic lymphatic drainage.