Successful percutaneous transhepatic lymphangiography and embolization for intractable hepatic lymphorrhea after laparoscopic distal gastrectomy: a case report

Background Hepatic lymphorrhea is a rare and serious complication of surgery for digestive tract cancers and is thought to occur as a result of lymph node dissection of the hepatoduodenal ligament. This complication results in the accumulation of lymphatic fluid, which may in turn lead to nutritiona...

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Bibliographic Details
Published in:Surgical case reports 2023-02, Vol.9 (1), p.28-28, Article 28
Main Authors: Harigane, Kohei, Nemoto, Hiroshi, Yoshida, Yoshiyuki, Komori, Hiromasa, Sarukawa, Hideki, Yazawa, Naoki, Miyamae, Taku
Format: Article
Language:English
Subjects:
Ascites
Case Report
Case reports
Embolization
Gastrointestinal surgery
Hepatic lymphorrhea
Laparoscopic distal gastrectomy
Laparoscopy
Lymphatic system
Medicine
Medicine & Public Health
Percutaneous transhepatic lymphangiography
Surgery
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Summary:Background Hepatic lymphorrhea is a rare and serious complication of surgery for digestive tract cancers and is thought to occur as a result of lymph node dissection of the hepatoduodenal ligament. This complication results in the accumulation of lymphatic fluid, which may in turn lead to nutritional disorders, immune deficiency, and circulation insufficiency. However, there is currently no standard strategy for treating this condition. Case presentation A 49-year-old woman with alcoholic liver damage underwent laparoscopic distal gastrectomy with lymph node dissection for early gastric cancer. Abundant ascites persisted postoperatively, and the fluid was suspected to indicate hepatic lymphorrhea. The patient was re-admitted on postoperative day 26 due to the onset of a brain infarction caused by dehydration. Various conservative treatments for hepatic lymphorrhea were ineffective. She underwent percutaneous transhepatic lymphangiography and embolization on postoperative day 81, with obvious effect. Computed tomography images demonstrated complete disappearance of ascites. Conclusions Postoperative hepatic lymphorrhea is a rare and serious complication of radical surgery for digestive tract cancers. The current case suggests that percutaneous transhepatic lymphangiography and embolization may be a rational treatment option when conservative treatments fail.
ISSN:2198-7793
2198-7793
DOI:10.1186/s40792-023-01615-w