Lymphocele

Lymphocele
Lymphocele
Specialty	Surgery

A lymphocele is a collection of

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]

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 (

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.

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.