1/116. Favorable outcome in a fetus with an early-onset extensive cystic hygroma colli and intralesional hemorrhage. We present a rare occurrence of an early-onset extensive cystic hygroma colli with intralesional hemorrhage and a favorable outcome. A 23-year-old primigravida woman was referred for management of a left isolated extensive cystic hygroma colli at 22 weeks' gestation. amniocentesis revealed a 46, XY karyotype. Ultrasound-guidance in utero paracentesis was performed weekly or fortnightly from 22 to 36 gestational weeks. The aspirated fluid was chocolate-colored and contained abundant lymphocytes, erythrocytes, and protein. Despite multiple aspirations, the fetal cystic hygroma colli increased in size from 5.2x4.2 cm at 22 weeks' gestation to 9x9.7 cm at 36 weeks' gestation. The woman underwent cesarean section at 36 week's gestation and a-2808 g neonate was born with a 10x6 cm left neck mass, which did not impair spontaneous normal respiration. At the age of 4 days, the neonate underwent simple excision of the cystic hygroma, which was confined to the anterior superficial neck. The neonate was discharged 4 days after operation in good condition. In the present case, in utero paracentesis did not prevent the progressive growth of an early-onset extensive cystic hygroma colli with intralesional hemorrhage. However, lack of extension of the lesion into the surrounding structures and successful postnatal surgery contributed to the favorable outcome of this patient. ( info) |
2/116. Chylous complications after abdominal aortic surgery. Two patients developed chylous complications following abdominal aortic aneurysm repair. One patient had chylous ascitis and was successfully treated by a peritoneo-caval shunt. The other patient developed a lymph cyst, which gradually resorbed after puncture. Chylous complications following aortic surgery are rare. patients in bad a general condition should be treated by initial paracentesis and total parenteral nutrition, supplemented by medium-chain triglyceride and low-fat diet. If no improvement is observed on this regimen, the next step should be implementation of a peritoneo-venous shunt, whereas direct ligation of the leak should be reserved for those who are not responding to this treatment. ( info) |
3/116. Laparoscopic drainage of giant lymphocele after renal transplantation. lymphocele is a relatively frequent complication of kidney transplantation. A 46-year-old man presented 2 years after kidney transplantation with a giant septated lymphocele. The patient underwent successful laparoscopic drainage of the collection and was discharged home on the day of the procedure. Laparoscopic drainage is a safe and effective treatment for complex lymphocele after kidney transplantation. ( info) |
4/116. Use of talcum in sclerotherapy of pelvic lymphoceles. Lymphoceles sometimes constitute an inconvenient problem after pelvic surgery combined with lymphadenectomy. We report on a case of a patient with carcinoma of the prostate treated by radical prostatectomy and pelvic lymphadenectomy, who developed a large pelvic lymphocele after surgery. The lymphocele was drained by a nephrostomy tube and sclerotherapy using a talcum solution was performed. Talcum is frequently used successfully in pleurodesis. The lymphocele disappeared within 2 weeks after one administration of the solution. sclerotherapy with a talcum solution can be recommended as a simple, safe, and effective method in pelvic lymphoceles. The single dose and the lack of side effects are advantageous to other agents. ( info) |
5/116. Bilateral groin adenolymphoceles: an unusual presentation of chylous reflux. We report an unusual presentation of a young man with bilateral groin lymph nodal adenolymphoceles and right leg lymphedema as a manifestation of intestinal lymphangiectasia. Chylous reflux was supported by conventional and isotopic lymphography as well as by a total lipid test showing delayed triglyceride absorption 24 hours after ingestion of 60 gm of butter. After excision of groin masses in conjunction with dietary control (short-medium chain triglycerides), manual massage, pneumatic compression, and long-term wearing of a low stretch elastic garments he remains well. ( info) |
6/116. thigh isosulfan blue injection in the treatment of postoperative lymphatic complications. Postoperative lymphatic complications after infrainguinal revascularization are troublesome and potentially serious complications. Vital dye injection into the web spaces of the foot has been recommended as a simple and reliable method to identify lymphatic channel disruption before groin exploration. Such distal injections, however, are not always successful. We describe a modified technique using a proximal thigh injection with isosulfan blue, which is faster and more useful than the distal web space method. ( info) |
7/116. Lymphoepithelial cyst of the pancreas. No evidence for Epstein-Barr virus-related pathogenesis. Compared to pseudocyst formation after prior pancreatitis, true cysts of the pancreas are rare. Pancreatic cysts with irregular wall components or a mucinous content raise the suspicion for the presence of a cystic neoplasm, and surgical resection is recommended. A case of a patient with a history of prostate cancer is described in whom a cyst of the pancreatic tail was discovered incidentally. Based on the radiographic features, which did not support the presence of a serous cystadenoma, a spleen-preserving distal pancreatectomy was performed. Histologic features were characteristic for a lymphoepithelial cyst (LEC) of the pancreas, lined with thinned squamous epithelium surrounded by benign lymphoid tissue. Since LECs of the parotid gland, which are associated with acquired human immunodeficiency, are frequently related to Epstein-Barr virus (EBV) infection, EBV in situ hybridization was performed and did not reveal evidence for EBV. Twenty-eight instances of pancreatic LECs have been reported, primarily affecting adult males, without evidence of increased numbers of EBV-positive cells. The pathogenesis, differential diagnosis, and clinical implications of lymphoepithelial pancreatic cysts are discussed. ( info) |
8/116. Lymphatic cyst of the colon: a case report. A rare case of a lymphatic cyst of the ascending colon is reported. The lobulated and fluctuant lesion, located in the hepatic flexure, was diagnosed by barium enema and colonoscopy, incidentally. Surgical treatment with segmental resection of the ascending colon was done because of the risk of obstruction and the question of an underlying malignancy. The clinical features, appropriate treatment, preoperative diagnosis and histopathology are discussed. We emphasize that lymphatic cysts are very rare and are difficult to identify by radiology or colonoscopy before surgery. They must be included in the differential diagnosis of submucosal tumors such as lipomas, leiomyomas and hemangiomas. ( info) |
9/116. Treatment of a retroperitoneal lymphocele after lumbar fusion surgery with intralesional povidone iodine: technical case report. OBJECTIVE AND IMPORTANCE: This case report illustrates an uncommon complication from the retroperitoneal exposure of the lumbar spine. The diagnosis and management of a retroperitoneal lymphocele is presented. The lymphocele was treated with intralesional povidone iodine (Betadine; Purdue-Frederick, Norwalk, CT), which eradicated the lesion and provided symptomatic relief to the patient. CLINICAL PRESENTATION: A young woman developed an iatrogenic, rapidly progressive spondylolisthesis after having undergone three previous lumbar surgeries for radiculopathy at the L5-S1 level. INTERVENTION: A back-front-back approach was used for operative reduction and fusion of the spondylolisthesis. The patient's postoperative course was complicated by a retroperitoneal lymphocele. She presented with symptoms of urinary urgency and incontinence. The lymphocele was successfully treated with repeated drainage and sclerosis with povidone iodine. The patient ultimately developed a solid fusion, and her pain resolved. CONCLUSION: A retroperitoneal lymphocele is an uncommon complication caused by the surgical exposure of the lumbar spine when a ventral approach is used. In this case, it was diagnosed and treated without further surgical intervention. ( info) |
10/116. Localized microcystic lymphatic malformations--ultrasound diagnosis. Microcystic lymphatic malformations present with a wide variety of clinical manifestations that may make diagnosis difficult. We present four patients with microcystic lymphatic malformations that have been confirmed by both histology and ultrasound appearance. Five further cases of microcystic lymphatic malformations with unusual presentations, in which ultrasound was used to support the diagnoses, are then presented. The use of ultrasound as a tool to aid in the diagnosis of microcystic lymphatic malformations is then discussed and compared with other investigative techniques. ( info) |