A case of left renal atrophy following the development of an infected giant retroperitoneal chylous cyst after laparosco
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CASE REPORT
A case of left renal atrophy following the development of an infected giant retroperitoneal chylous cyst after laparoscopic para‑aortic lymphadenectomy for endometrial cancer Takuma Ohsuga1 · Yasushi Kotani1 · Shiro Takamatsu1 · Keisuke Murakami1 · Hidekatsu Nakai1 · Noriomi Matsumura1 Received: 19 February 2020 / Accepted: 27 May 2020 © The Japan Society of Clinical Oncology 2020
Abstract Chylous leakage is caused by interruption of lymphatic vessels carrying triglyceride-rich lymph during para-aortic lymph node dissection in patients with gynecological malignancies. Our search of literature revealed no report like our case that the renal atrophy was late onset after healing of the chylous cyst infection. A case is 60-year-old. She was preoperatively diagnosed with endometrial cancer, endometrioid carcinoma FIGO grade 3, stage IA of the FIGO system. Laparoscopic-modified radical hysterectomy, bilateral salpingo-oophorectomy, pelvic and paraaortic lymphadenectomy and partial omentectomy were performed. On the 16th postoperative day, a percutaneous drainage was performed, and revealed chylous effusion from the lymph cyst. The drainage tube was removed, and she discharged on the 34th postoperative day. On the 99th postoperative day, a follow-up plain CT to check for a recurrence of endometrial cancer revealed atrophy of left kidney. It is probable that the chylous leakage was the primary cause of renal atrophy. Therefore, it is crucial to prevent chylous leakage during surgery to avoid repeating the same complication again. Keywords Para-aortic lymphadenectomy · Renal atrophy · Chylous leakage
Introduction Lymphoceles and lymphedemas are well-known complications that develop after lymphadenectomy in patients with gynecological malignancies. Chylous leakage is caused by interruptions in lymphatic vessels, which carry triglyceriderich lymph fluid, during para-aortic lymph node dissection. The reported incidence of chylous leakage after lymphadenectomy for gynecologic malignancies is estimated at 0.17–0.9% [1, 2]. Dietary adjustment is the standard initial treatment, specifically, with either a low-fat, high-protein diet supplemented with medium-chain triglycerides or fasting with total parenteral nutrition [3]. Somatostatin or octreotide, its synthetic analog, can be administered in patients * Yasushi Kotani y‑[email protected] 1
Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, 377‑2 Ohno‑higashi, Osaka‑sayama, Osaka 589‑8511, Japan
who do not respond to initial therapy [4]. If conservative measures fail, therapeutic paracenteses and surgical procedures, including direct ligation of the sources of chylous leakage, are considered [5]. Recently, it was reported that lymphangiographies may also be therapeutic for chylous leakage [6]. In our case, a patient with a preoperative diagnosis of endometrial cancer, endometrioid carcinoma FIGO grade 3, stage IA of the FIGO system, underwent laparoscopic surgery (including para-aortic lymphadenectomy). After the operatio
