Lymphatic Embolization for Lymphatic Leakage After Pelvic Lymph Node Dissection: Case Report

Abstract

Introduction

Radical cystectomy with pelvic lymph node dissection for muscle-invasive bladder cancer may be complicated by postoperative lymphatic leakage when high-output drainage persists despite conservative management. We describe treatment of diffuse lymphoascites after pelvic lymph node dissection using upstream lymphatic embolization.

Case Presentation

A man in his 70s developed lymphatic leakage with drainage > 1000 mL/day after radical cystectomy and pelvic lymph node dissection. Lymphoscintigraphy showed bilateral iliac leakage with diffuse intraperitoneal spread, making local sclerotherapy unsuitable. Intranodal lymphangiography via bilateral inguinal nodes identified iliac lymphatic duct leaks. Upstream embolization with a N-butyl cyanoacrylate–ethiodized oil mixture through multiple inguinal nodes rapidly reduced drainage, allowing drain removal by day 4 and discharge by day 10 without persistent lymphedema.

Conclusion

Upstream lymphatic embolization is a minimally invasive option for refractory high-output lymphatic leakage after pelvic lymph node dissection.