2022 Volume 40 Issue 1 Pages 1-9
Lymphorrhea is a relatively rare postoperative complication after retroperitoneal lymph node dissection. Normally, a lymphatic leakage closes spontaneously before it becomes symptomatic. However, some severe, prolonged cases require immediate treatment. Here, we report a case requiring a multidisciplinary intervention for a diagnosis and ascites effusion control after radical hysterectomy. A 41-year-old nulliparous woman with a chief complaint of abnormal vaginal bleeding was referred to our institution. We performed radical hysterectomy, including pelvic lymph node dissection after neoadjuvant chemotherapy based on a cervical cancer stage IIB diagnosis. On postoperative day 52, massive ascitic fluid without chyle developed. Conservative treatment failed to control the ascites, and approximately 36 L of ascites was drained over three months. Subsequent lipoprotein analysis of the ascites detected chylomicron, resulting in a lymph ascites diagnosis owing to postoperative lymph leakage. We performed lymph embolization by lymphangiography and ligation of lymphatic leakage by laparotomy. Finally, we performed lymphaticovenular anastomosis, which relieved the lower limb lymphedema without causing ascites relapse. If ascitic fluid is observed after lymph node dissection, lymphatic ascites should be considered regardless of the presence of chyle.
