What is Lymphocele?Lymphocele is a term that describes the abnormal collection of lymph fluid in a cavity or sac following a surgical procedure. Lymphocele may also be called lymphocyst, the term that describes the phenomenon until the early 70s, because it creates a cyst like appearance. The lymphatic system is a network of fluid that forms when interstitial fluid enters the lymphatic ducts. Fluid in the lymphatic system is called lymph fluid. Once a lymphatic channel is injured, leakage occurs and a cyst filled with lymphatic fluid may develop in cavities or sacs. Lymphoceles also lack epithelial lining which are true for other forms of cysts. The fluid remains as fluid over periods of time because the lymph vessels lack platelets and have low clotting factors. Lymphocele was first studied in 1955 after studying several cases of lymphocele in hysterectomy patients.
CausesLymphoceles commonly occur in patients who have undergone surgical procedures that involved injury to large portions of the lymphatic system as in major operations. Lymphocele are often a result of surgery complications. Any injury to the lymphatic vessels causes leakage and swelling and subsequently leads to lymphocele. However, lymphocele should be differentiated with other complications of surgery such as hematoma, abscess formation and seroma—all of these having similar signs and symptoms to lymphocele. The following outlines the most common causes of lymphocele development.
Lymphocele after Renal TransplantRenal transplant involves a major surgery that may injure underlying lymphatic channel. Damage to the lymphatic vessel should be carefully avoided to prevent lymphocele because this can lead to organ rejection or malfunction.
Lymphocele after Thoracic SurgeryThoracic surgery is another common major operation that can lead to lymphocele. Lymph fluid tends to accumulate in the mediastinum that can compress structure such as the lungs and the heart.
Lymphocele after Radical HysterectomyHysterectomy is done with patients who have uterine cancer. Damage to the lymphatic vessel is imminent in this type of surgery so surgeons usually place drains to prevent accumulation of lymph fluid.
Lymphocele after LymphadenectomyLymphadenectomy is the removal of lymph nodes. Aortic and pelvic lymphadenectomy is responsible for almost half of lymphocele cases.
Other Causes of LymphoceleLymphocele can also be caused by blunt or crushing injuries to the lymphatic vessels such as in motor-vehicular accidents. One documented case is the occurrence of such after arthroscopy, the examination and visualization of the joint.
Prevention of lymphocele as a result of surgery involves placing of drains to remove lymph fluid and prevent accumulation. This has been a protocol for surgeries that have the tendency to develop lymphocele.
SymptomsLymphocele presents symptoms depending on the location. The following bullets outline the most common manifestations of the disease:
- Severe Fatigue
- Localized fluid accumulation
- Discoloration of the skin above the lymphocele
- Pain on the affected area due to compression of nerve endings
- Swelling and edema on the area where the lymphatic fluid accumulates
DiagnosisDiagnosis of lymphocele includes imaging studies to confirm location and presence of the cysts such as:
Magnetic Resonance ImagingThis involves the use of magnetic waves in visualizing the internal organs and any fluid accumulation.
Computed Tomography Scan (CT-scan)Computed tomography scans are effective in identifying lymphocele since it uses series of x-rays to visualize all angles of the area being examined.
UltrasoundUltrasound is also essential in diagnosing the lymphocele and it is more cost effective than CT scans and MRIs. Ultrasound can be used in soft tissues while the more expensive CT scan and MRI are for tough structures such as tendons, ligaments and bones.
TreatmentSurgeons usually place drains such as Jackson-Pratt and Hemovac drains on the post-operative site to drain lymphatic fluid. According to one research, placing post operative drains is 80% effective in preventing lymphoceles and any fluid collection in cavities. However, when lymphocele is already present, lymphocele drainage is done.
Lymphocele DrainageLymphocele treatment involves creating an opening and draining the lymphatic fluid from the site. Lymphocele is treated as an emergency case which needs an immediate action such as lymphocele drainage.
Lymphocele drainage involves the insertion of intra peritoneal Tenckhoff catheter or percutaneous cathether to allow the fluid to drain. During lymphocele drainage, ultrasound guidance is needed to have visualization of the inner cavity to be drained and for accurate insertion of the catheter.
Tenckhoff CatheterTenckhoff catheters are flexible, thin catheters inserted in the peritoneum to drain lymphoceles as a result of abdominal surgeries. A surgeon usually inserts the catheter with appropriate anesthesia. This procedure may be uncomfortable or painful to some patients. Careful insertion is done to ensure that the catheter is placed where it is intended to go.
Other Percutaneous CathetersOther types of catheter may be used. The size of the catheter depends on the body size of the patient. Pediatric clients normally use the smallest catheter possible.
Preparation for the Lymphocele DrainageDepending on hospital policies, the following are the most common preparations for the procedure: The patient is instructed not to consume foods or fluids (Nothing per Orem) eight to 12 hours before the procedure to prevent pulmonary aspiration and distention of the abdomen. The patient is instructed to void and move bowel prior to the drainage to prevent accidental puncture of distended bladder and bowel. The insertion site is shaved to remove hair that will potentially harbor microorganisms. This prevents infection to the client. A skin preparation is done by applying iodine solution over the skin to be punctured to ensure a sterile procedure. A topical lidocaine may be used as a form of anesthesia. The patient is instructed to inhale deeply as the catheter is being inserted to reduce pain sensation and relax the muscles for easy insertion.
Activities after Lymphocele DrainageAfter lymphocele drainage, a peritoneal lavage (washing) is done using povidone iodine diluted in normal saline solution to clean the area and remove any potentially harmful microorganisms.
Fluids that were removed or aspirated should be checked for protein, culture and Grams stain to determine any underlying infections. Aside from this, triglycerides, cholesterol and creatinine should be checked in the fluid to rule out liver and kidney problems associated with the lymphocele. Patients are also prescribed with analgesics to reduce the pain sensation as a result of the catheter insertion.