Postoperative External Transabdominal Severe Lymphorrea (Case Report)

Massive lymphorrhea can cause severe dysfunction of organs and systems and result in death due to loss of vital metabolites from the body
Aim. To demonstrate low efficacy of conservative therapy and late lymph duct ligation in continuous massive postoperative lymphorrhea.
Results. We treated a patient with previous subtotal gastric resection with single-plane pancreatic resection, D2 lymph node dissection, peritoneal draining due to poorly differentiated carcinoma in the lower third of stomach and total hysterectomy who developed external lymphorrhea through peritoneal drainage tubes 3 days after surgery. A fat-rich diet, endolymphatic sodium etamsylate administration, and lymphatic duct ligation were not successful in terminating the lymph leakage. Despite the intensive care including extracorporeal detoxification, the multi-organ failure progressed and on day 28 after the surgery the patient was pronounced dead.
Conclusion. Damage to lymph ducts and lymph nodes can be complicated by massive lymphorrhea. If the source of lymphorrhea can be identified, an urgent surgical intervention is warranted to stop the lymph leakage, as well as the restoration of homeostasis to replenish the lost metabolites and prevent death of the patient.

1. Panchenkov R. T., Vyrenkov Yu. E., Yarema I. V., Urtaev B. M. Lym-phosorption. M., 1982: 240 [In Russ.].

2. Kursov S.V., Mikhnevich K.G. Capillary leak Syndrome. Meditsina neotlozhnyh sostoyanij. 2011; 7: 24-32 [In Russ.].

3. Konenkov V.I., Borodin Yu.I., Lyubarsky M.S. Lymphology. Monograph. Novosibirsk: Publ. house «Manuscript», 2012. 1104 p [In Russ.]

4. Tsarapkin Yu. E., Yarema R. I., Levin D.V. Theoretical substantiation of endolymphatic lymphostatic therapy with the account of coagulative activity of lymph. Khirurg. 2010; 4: 55-61 [In Russ.].

5. Boldt J. Fluid choice for resuscitation of the trauma patient: a review of the physiological, pharmacological, and clinical evidence. Can. J. Anaesth. 2004; 5 (51): 500-513. PMID: 15128639 DOI: 10.1007/BF03018316

6. Fishel R.S., Are C., Barbul A. Vessel injury and capillary leak. Crit. Care Med. 2003; 31 (Suppl. 8): 502-511. PMID: 12907879 DOI: 10.1097/01.CCM.0000081431.50015.46

7. Tsarapkin J. E., Zykov A.E., Yarema R.I., Jideleva E.A. Postmastectomy lymphorrhea. Khirurg. 2010; 5: 43-46 [In Russ.].

8. Moroz V.V., Lukach V.N., Shifman E.M., Dolgikh V.T., Yakovleva I.I. Sepsis. Clinical and pathophysiological aspects of intensive care. Petrozavodsk, 2004: 245 [In Russ.].

9. Gardubey E.Yu., Selishchev V.V., Svyrydov V.O., Vatsuro M.F. The method of treatment of lymphorrhea after reconstruction of the lower extremities arteries. Klin Khir. 2015; (9): 63-64. PMID: 26817092

10. Ghezzi F., Uccella S., Cromi A., Bogani G., Robba C., Serati M., Bolis P. Lymphoceles, lymphorrhea, and lymphedema after laparoscopic and open endometrial cancer staging. Ann Surg Oncol. 2012; 19 (1): 259-267. PMID: 21695563 DOI: 10.1245/s10434-011-1854-5

11. Grigoryants L. A., Lazechko M. I., Vlasenko T. Yu., Yarema V. I., Deryushkin V. G., Kononova Yu. A., Yarema I. V. Experience in the use of oral direct anticoagulant pradax in the treatment of radiation xerostomy. Vestnik poslediplomnogo meditsinskogo obrazovaniya. 2018; 4: 61-64 [In Russ.].

12. Kaplan M. A., Shubina A.M., Borgul O. V. Nikitina R.G. Intravenous photodynamic therapy: first experimental and clinical data. Voprosy onkologii. 2010; 3: 345-347 [In Russ.].