CT-Guided Intranodal Lymphangiography for Postoperative Chylous Ascites

Abstract

The utility and minimal invasiveness of ultrasound-guided intranodal lymphangiography have already been reported by several researchers. Although ultrasound-guided intranodal lymphangiography is known to be not technically difficult in general, a patient's edematous groin due to hypoalbuminemia resulting from chylous ascites made it too challenging to detect and prick the lymph nodes precisely. This report describes a 71-year-old female with refractory chylous ascites due to an operation for an extrahepatic bile duct cancer, who was successfully treated by computed tomography (CT)-guided intranodal lymphangiography. After switching from ultrasound- to CT-guided lymphangiography, the procedure was successfully performed, and the refractory chylous ascites was treated.

Conventional Lymphangiography (CL) in the Management of Postoperative Lymphatic Leakage (PLL): A Systematic Review

“…These 28 articles included 5 large original case series with > 10 patients (Category I data) and 3 small original case series with 3-9 patients (Category II data) [15,[19][20][21][22][23][24][25]. The other 20 articles included were case reports and other short reports such as letters to the editor and technical notes with < 3 patients (Category III data) [14,17,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. None of these articles included a prospective study or a randomized controlled trial.…”

“…Under consideration of Category III data, further types of causal surgery include different conventional (e. g. hemihepatectomy) and minimally invasive (e. g. exploratory laparoscopy including peritoneal washing and omental and peritoneal biopsies) procedures [31,41]. Compared with Category I data and Category II data, the clinical presentation of PLL is extended, and includes also chyluria and a PLL volume of up to 6000 ml/day [26,32].…”

“…Under consideration of Category III data, the PLL cure rate is 100 % in 4 articles with transpedal CL and 14 articles with intranodal CL (and n.s. in 2/20 articles [1 article with transpedal CL and 1 article with intranodal CL]) [17,[26][27][28][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. In the article of Hara et al with 1 patient with chylothorax (PLL volume of 1000 ml/day), intranodal CL was performed twice at an interval of 1 month (bilateral groin access for the first CL and bilateral groin and bilateral axilla access for the second CL) until PLL cure was observed [37].…”