TY - JOUR
T1 - A Case of Severe Lower Extremity Lymphedema Caused by Postoperative Intraperitoneal Lymphatic Leakage Treatment
AU - Tsukura, Kahori
AU - Onoda, Satoshi
AU - Tachibana, Gaku
AU - Kobayashi, Kohta
AU - Katsuragi, Ryohei
AU - Satake, Toshihiko
N1 - Publisher Copyright:
Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.
PY - 2024/3/4
Y1 - 2024/3/4
N2 - In the present study, we encountered a patient who developed intraabdominal lymphatic leakage after surgery for gastric cancer, underwent lymphangiography and lymphatic mass embolization, and developed severe lymphedema. The patient was a 55-year-old woman with gastric cancer with pancreatic invasion. Total gastrectomy and lymph node dissection were performed as conversion procedures. Six liters of ascites was detected postoperatively. Lymphangiography with Lipiodol injections into the bilateral inguinal lymph nodes was done three times, and Histoacryl embolization of the lymphatic leak was performed. However, edema of the lower extremities rapidly worsened. Lymphatic venous anastomosis was performed under general anesthesia. Anastomosis was performed at seven sites on the right and eight sites on the left. Postoperatively, the patient underwent compression therapy using the multilayer bandage method. The edema continued to improve further, and at 2 weeks postoperatively, the patient's weight had decreased by 21.4kg from the preoperative weight, which was the same as that before the onset of edema. In this case, the patient's general condition was unstable due to cardiac insufficiency and other factors. Therefore, we aimed for an operation time of less than 3 hours. In addition, two surgeons performed the surgery to ensure an immediate therapeutic effect, and more anastomoses were performed than usual. After lymphatic venous anastomosis, not only the edema of both lower extremities but also the edema of the entire body improved promptly. One of the reasons for the improvement in general edema was thought to be due to increased intravascular protein and enhanced intravascular return of interstitial fluid.
AB - In the present study, we encountered a patient who developed intraabdominal lymphatic leakage after surgery for gastric cancer, underwent lymphangiography and lymphatic mass embolization, and developed severe lymphedema. The patient was a 55-year-old woman with gastric cancer with pancreatic invasion. Total gastrectomy and lymph node dissection were performed as conversion procedures. Six liters of ascites was detected postoperatively. Lymphangiography with Lipiodol injections into the bilateral inguinal lymph nodes was done three times, and Histoacryl embolization of the lymphatic leak was performed. However, edema of the lower extremities rapidly worsened. Lymphatic venous anastomosis was performed under general anesthesia. Anastomosis was performed at seven sites on the right and eight sites on the left. Postoperatively, the patient underwent compression therapy using the multilayer bandage method. The edema continued to improve further, and at 2 weeks postoperatively, the patient's weight had decreased by 21.4kg from the preoperative weight, which was the same as that before the onset of edema. In this case, the patient's general condition was unstable due to cardiac insufficiency and other factors. Therefore, we aimed for an operation time of less than 3 hours. In addition, two surgeons performed the surgery to ensure an immediate therapeutic effect, and more anastomoses were performed than usual. After lymphatic venous anastomosis, not only the edema of both lower extremities but also the edema of the entire body improved promptly. One of the reasons for the improvement in general edema was thought to be due to increased intravascular protein and enhanced intravascular return of interstitial fluid.
UR - http://www.scopus.com/inward/record.url?scp=85186639395&partnerID=8YFLogxK
U2 - 10.1097/GOX.0000000000005648
DO - 10.1097/GOX.0000000000005648
M3 - 学術論文
C2 - 38440370
AN - SCOPUS:85186639395
SN - 2169-7574
VL - 12
SP - E5648
JO - Plastic and Reconstructive Surgery - Global Open
JF - Plastic and Reconstructive Surgery - Global Open
IS - 3
ER -