Late aortic lymphocele and residual ovary syndrome after gynecological surgery

Abstract

Background: Gynecological surgery, as radical hysterectomy or pelvic and aortic lymphadenectomy, accounts for more than 50% of iatrogenic injuries. In premenopausal women, an hysterectomy with ovarian sparing and concomitant lateral ovarian transposition is frequently performed. However, the fate of the retained ovary is complicated by the residual ovarian syndrome (ROS) and one of the most common postoperative complications of the lymphadenectomy procedure is the lymphocele, with an average incidence of 22-48.5%. The differential diagnosis of a postoperative fluid collection includes, in addition to a lymphocele, urinoma, hematoma, seroma or abscess and the computed tomography (CT) findings alone is not enough.

Nonovarian Cystic Lesions of the Pelvis

“…It occurs in 12%-24% of patients who undergo radical lymphadenectomy, and it usually is detectable 3-8 weeks after surgery (23). The symptoms of a lymphocele depend on its size and location and whether a superinfection is present (28). It is important to differentiate between lymphocele and other postoperative complications such as hematoma, seroma, abscess, and cystic tumor recurrence, because the clinical management of each condition is different.…”

Masse kystique postopératoire

“…Le délai de survenue en postopératoire est variable, en moyenne trois à huit semaines ; le plus souvent au cours de la première année [4,5]. Des survenues tardives au-delà de la première année doivent faire rechercher une récidive tumorale associée [6]. Certains facteurs de risque prédisposent à l'apparition de lymphocèles, notamment une héparinothérapie postopéra-toire, une radiothérapie externe et une atteinte ganglionnaire métastatique [1,4].…”

“…L'urinome correspond à une collection secondaire à une fuite urinaire, se rehaussant au temps excrétoire. L'abcès se manifeste par une prise de contraste périphérique, avec un contexte clinique évocateur [3,5,6]. Quand la lymphocèle est petite asymptomatique, une simple surveillance par échographie ou par TDM peut être préconisée.…”

Development of late, symptomatic abdominopelvic lymphoceles more than 10 years following pediatric reconstructive urologic procedures

“…To discern between the two, a CT scan with administration of IV contrast is recommended. Late infection of lymphoceles has been previously described in case reports following prostatectomy and gynecologic oncology surgery [8,9]. The presumed source of infection is generally transient bacteremia from skin inoculation [8], but also can be related to perioperative drain use or other sources of sepsis, including urinary tract infections.…”

“…Symptomatic lymphoceles will present within 2e12 months following surgery more than 80% of the time; therefore, presentation beyond 1 year following surgery is rare [7]. The latest reported lymphocele as a complication of pelvic lymphadenectomy for prostate cancer occurred 20 months postoperatively [8]; however, delayed presentations of symptomatic abdominopelvic lymphoceles have been reported up to 12 years following non-urologic surgery in adult patients [9].…”