Definition and Overview

Lymphocele is a postsurgical complication that develops when the lymphatic system gets damaged during surgery. This damage causes the lymph fluid to drain out from the lymphatic channel and then build up in a nearby cavity. Lymphocele, which is most commonly associated with extensive surgical procedures such as kidney transplantation and urological pelvic surgery, is usually found in the retroperitoneal space.

If not treated on time, lymphocele can obstruct blood flow to the treated site and compress surrounding blood vessels. Poor blood supply delays wound healing and increases the risk of infection.

Causes of Condition

The majority of lymphoceles develop when the lymphatic channel becomes damaged or injured during certain surgical procedures, such as:

  • Radical hysterectomy, which is performed as part of cervical cancer treatment. It involves the removal of the uterus and tissue fibers that hold it in place.

  • Kidney transplantation - Lymphocele occurs in 20% of kidney transplant patients. The condition increases the risk of organ rejection.

  • Thoracic surgery - This refers to any surgical procedure performed to treat a number of diseases that affect the chest, such as lung and oesophageal cancers, mesothelioma, and chest wall tumours. This procedure increases the risk of lymphocele because the mediastinum contains several lymph channels that could easily get damaged during surgery.

  • Lymphadenectomy - The surgical removal of lymph nodes commonly performed to prevent cancer from spreading to other parts of the body.

  • Radical pelvic surgery - A procedure performed for the treatment of gynaecologic or prostatic cancer.

Aside from surgery, other factors that can damage the lymphatic system include crushing or blunt injuries.

Lymphocele can also form on the penis and occurs in sexually active males. Lymphocele of the penis is generally harmless and does not require any treatment. The condition develops due to vigorous masturbation or prolonged, intense sex sessions and is characterised by the presence of what looks like a horizontal or vertical swollen cord. It results in the temporary blockage of lymph channels in the penis.

Key Symptoms

Lymphoceles start to produce symptoms when they grow in size and start to compress adjacent structures. These symptoms can vary depending on the lymphocele’s location.

A lymphocele in the abdomen, for example, can compress the large intestine, which could result in intestinal obstruction and constipation. A lymphocele in the pelvic region, on the other hand, can cause swelling in the legs and genitals. It can also irritate the urinary bladder that can result in urinary tract infection or increased frequency of urination.

If left untreated, the condition may cause serious complications, including:

  • Lymphatic fistula formation

  • Pulmonary embolism

  • Venous thrombosis

Who to See and Types of Available Treatments

Small lymphoceles do not cause any symptoms and thus, do not require any form of treatment. However, large ones can cause pain and swelling. Certain therapies are performed in such cases to provide symptoms relief.

The standard treatment for the condition is lymphocele drainage under CT or ultrasound guidance. By draining the fluid that has accumulated in the affected area, the patient will experience immediate symptoms relief. Prior to the procedure, the patient undergoes pre-operative preparations and a number of tests. These include blood tests to check the function of the kidney and liver as well as imaging tests such as magnetic resonance imaging (MRI), computed tomography (CT) scan, and ultrasound.

During the procedure, the doctor guides a needle into the lymphocele to obtain a small amount of lymphatic fluid, which is then sent to a laboratory for testing. This is performed prior to draining the remaining fluid to determine if there is an infection, which will affect the course of treatment. If no infection and other medical problems have been found, the doctor will proceed by inserting a catheter into the lymphocele to drain the remaining fluid. This is followed by the injection of a sclerosing agent via the same catheter to destroy the lining of the lymphocele so it will collapse, which will prevent the fluid from accumulating again in the same site. The process of draining the fluid and the application of a sclerosing agent is repeated numerous times over the course of several days.

Meanwhile, lymphocele of the penis does not require any treatment. Instead, patients are advised to refrain from sex and masturbation for about six weeks or until the condition resolves itself.

References:

  • Kim JK, Jeong YY, Kim YH, Kim YC, Kang HK, Choi HS (1999). "Postoperative Pelvic Lymphocele: Treatment with Simple Percutaneous Catheter Drainage". Radiology. 212: 390–94. doi:10.1148/radiology.212.2.r99au12390.

  • Jump up ^ Petru E, Tamussino K, Lahousen M, Winter R, Pickel H, Haas J (1989). "Pelvic and paraaortic lymphocysts after radical surgery because of cervical and ovarian cancer". Am J Obstet Gynecol. 161: 937–41

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