Delayed lymphocele formation following lateral lumbar interbody fusion of the spine

Hey, Hwee Weng Dennis; Wong, Kainam Thomas; Gatam, Asrafi Rizki; Lim, Jimmy; Wong, Hee-Kit

doi:10.1007/s00586-016-4678-y

Cited by 11 publications

(5 citation statements)

References 27 publications

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“…58,64,71 Lymphoceles are often detected between 12 days and 6 months after surgery, but can be detected later, even years after surgery. 62,[72][73][74][75] This may be because some patients are only imaged when they become symptomatic, and the lymphocele may have been present but asymptomatic until imaging was done. However, this may also highlight the fact that lymphoceles develop slowly, with less factors limiting their growth compared with hematomas, owing to the low concentrations of clotting factors and absence of smooth muscle cells in lymphatic vessels.…”

Section: Etiologymentioning

confidence: 99%

Chylous Ascites and Lymphoceles: Evaluation and Interventions

Santos

Moussa

2020

Semin intervent Radiol

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Kinmonth introduced lymphangiography in 1955 and it became an important tool in the diagnosis and treatment of malignant disease. The technique, based on bipedal approach, was difficult and time-consuming which limited its use in clinical practice. Cope is the father of percutaneous lymphatic interventions and he was the first person to access and intervene on the lymphatic system. After his initial work published on 1999, there has been an expansion of the lymphatic embolization techniques, particularly since the development of intranodal lymphangiography and advance lymphatic imaging. This article is focused on the evaluation and management of postoperative chylous ascites and lymphoceles. Their incidence is growing due to longer survival of cancer patients and more radical surgical approaches, leading to an increased morbidity and mortality in this patient population. Minimally invasive percutaneous lymphatic embolization is becoming a first-line therapy in patients with postoperative lymphatic leakage.

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Section: Etiologymentioning

confidence: 99%

Chylous Ascites and Lymphoceles: Evaluation and Interventions

Santos

Moussa

2020

Semin intervent Radiol

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“…Potential types of retroperitoneal fluid collections include hematoma; CSF collection; urinoma; chyloperitoneum; and encapsulated, infected fluid collection. 23,[25][26][27][28][29][30] We suspect the patient in this case had a lymphocele that was secondarily infected following his ALIF. Lymphoceles can result from dissection of the aorta and iliac vessels, causing disruption of lymphatic vessels.…”

Section: Discussionmentioning

confidence: 84%

“…Fluid specimens were analyzed with cell counts, triglycerides, and cultures for infectious agents. 26 , 27 If urinoma had been suspected, the fluid’s creatinine and urea would have been analyzed and compared to serum levels. When the fluid collection recurred, we performed open debridement of the thick capsule and its contents.…”

Section: Discussionmentioning

confidence: 99%

An unusual case of a persistent, infected retroperitoneal fluid collection 5 years after anterior lumbar fusion surgery: illustrative case

Neal¹,

Curley²,

Richards³

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUNDAnterior lumbar fusion procedures have many benefits and continue to grow in popularity. The technique has many potential approach- and procedure-related complications. Symptomatic retroperitoneal fluid collections are uncommon but potentially serious complications after anterior lumbar procedures. Collection types include hematomas, urinomas, chyloperitoneum, cerebrospinal fluid collections, and deep infections.OBSERVATIONSThe authors present an unusual case of a patient with persistent symptoms related to a retroperitoneal collection over a 5-year period following anterior lumbar fusion surgery. To the authors’ knowledge, no similar case with such extensive symptom duration has been described. The patient had an infected encapsulated fluid collection. The collection was presumed to be a postoperative lymphocele that was secondarily infected after serial percutaneous drainage procedures.LESSONSWhen retroperitoneal collections occur after anterior retroperitoneal approaches, clinical clues, such as timing of symptoms, hypotension, acute anemia, urinary tract infection, hydronephrosis, elevated serum creatinine and blood urea nitrogen, low-pressure headaches, anorexia, or systemic signs of infection, can help narrow the differential. Retroperitoneal collections may continue to be symptomatic many years after anterior lumbar surgery. The collections may become infected after serial percutaneous drainage or prolonged continuous drainage. Encapsulated, infected fluid collections typically require surgical debridement of the capsule and its contents.

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“…Chyloretroperitoneum after anterior spinal arthrodesis was described by Shen et al in 1989 5 , and isolated cases of postoperative chylous or lymphatic leakage have since been documented (Table I) 1,3-13 . Joubert et al 13 identified that 75.8% of cases presented with clinical symptoms after discharge, predominantly symptoms of mass effect.…”

Section: Discussionmentioning

confidence: 97%

Lymphatic Injury with Lymph Fistula After Anterior Lumbar Fusion Managed with Vacuum-Assisted Closure

Hartnett

Zhang

Hogan

et al. 2021

JBJS Case Connector

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Case: A 40-year-old man underwent an L5-S1 anterior lumbar interbody fusion (ALIF) and subsequently developed abdominal distention and persistent wound drainage. During wound reexploration, a substantial lymphocele and lymphatic fistula tracking from the ALIF site were visualized and evacuated. The deep space was coated with fibrin sealant. A deep drain and wound vacuum were placed within the retroperitoneal cavity, leading to progressive recovery. Conclusion: Intraoperative lymphatic injury during anterior spinal surgery can progress to the development of a lymphocele and lymphatic fistula, manageable with an exploratory laparotomy, fibrin sealant, and the use of a wound vacuum to promote fistula sealing.

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Delayed lymphocele formation following lateral lumbar interbody fusion of the spine

Cited by 11 publications

References 27 publications

Chylous Ascites and Lymphoceles: Evaluation and Interventions

Chylous Ascites and Lymphoceles: Evaluation and Interventions

An unusual case of a persistent, infected retroperitoneal fluid collection 5 years after anterior lumbar fusion surgery: illustrative case

Lymphatic Injury with Lymph Fistula After Anterior Lumbar Fusion Managed with Vacuum-Assisted Closure

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