Successful Surgical Treatment of Retroperitoneal Lymphocele after an Abdominal Aortic Aneurysm Repair

Toshiyuki Kuwata Nobuoki Tabayashi Tetsuji Kawata
Takehisa Abe Takashi Ueda Shigeki Taniguchi

(Third Department of Surgery, Nara Medical University, Nara, Japan)

Retroperitoneal lymphocele is a very rare complication of abdominal aortic aneurysm repair. An abdominal aortic aneurysm 5cm in diameter was repaired with the retroperitoneal approach in a 70-year-old man. On the 17th postoperative day, mild abdominal distention was reported and a fever of 38℃ had developed. A computed tomography scan demonstrated massive fluid collection in the retroperitoneal cavity. Total parenteral nutrition with complete fasting was initiated. A pigtail catheter was inserted into the cavity, and 1,000ml of milky, odorless, alkaline and sterile fluid was drained. Subsequently, a retroperitoneal lymphocele following abdominal aortic surgery was diagnosed. The leaking lymph tract was ligated because the lymphocele did not improve with long term drainage. Administration of ice cream through the nasogastric tube was used to detect the leaking lymph tract, and we ligated the leaking lymph tract completely. We believe that surgical repair is an alternative strategy when conservative treatments, i.e., fasting, intravenous hyperallimentation and drainage are not effective.   
 Jpn. J. Cardiovasc. Surg. 31: 224-226(2002)