Hepatic lymphorrhea following pancreaticoduodenectomy: Preliminary diagnosis and treatment experience from case series of four patients

Thanh Khiem Nguyen; Tuan Hiep Luong; Ngoc Cuong Nguyen; Ham Hoi Nguyen; Van Khang Le; Hong Son Trinh; Hai Dang Do; Van Duy Le; Ngoc Hung Nguyen

doi:10.1016/j.amsu.2021.102648

Hepatic lymphorrhea following pancreaticoduodenectomy: Preliminary diagnosis and treatment experience from case series of four patients

Ann Med Surg (Lond). 2021 Jul 29:68:102648. doi: 10.1016/j.amsu.2021.102648. eCollection 2021 Aug.

Authors

Thanh Khiem Nguyen¹, Tuan Hiep Luong², Ngoc Cuong Nguyen³, Ham Hoi Nguyen¹, Van Khang Le⁴, Hong Son Trinh⁵, Hai Dang Do², Van Duy Le¹, Ngoc Hung Nguyen¹

Affiliations

¹ Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Bach Mai Hospital, Hanoi, Viet Nam.
² Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam.
³ Department of Diagnostic and Interventional Radiology, Hospital of Hanoi Medical University, Hanoi, Viet Nam.
⁴ Department of Diagnostic and Interventional Radiology, Bach Mai Hospital, Hanoi, Viet Nam.
⁵ Department of Oncology, Viet Duc University Hospital, Hanoi, Viet Nam.

Abstract

Introduction: Hepatic lymphorrhea (HL) is an uncommon but potentially life-threatening type of postoperative lymphatic leakage, especially following pancreaticoduodenectomy.

Case presentation: We herein report a case series of four patients with HL following pancreaticoduodenectomy that presented to the department with a severe clinical picture with the discovery in imaging and intraperitoneal fluid's tests. All our patients presented with a condition of Hepatic lymphorrhea secondary to pancreaticoduodenectomy, which were treated successfully with percutaneous hepatic lymphangiography (HLG).

Discussion: Hepatic lymphorrhea is an uncommon but potentially life-threatening complication following pancreaticoduodenectomy. Periportal lymphatic vessels, which was often isolated and dissected especially with extended lymphadenectomy, is potentially damaged and caused resistant chylous leakage. Newly techniques are updated and applied in diagnosis and treatment for this difficult-to-treat complication, one of them is percutaneous Hepatic Lymphangiography (HLG).

Conclusion: HLG with percutaneous access could be effective to identify and terminate the chylous fistula from periportal lymphatic vessels after pancreaticoduodenectomy.

Keywords: Case series; Extended lymphadenectomy; Hepatic lymphorrhea; Pancreatic cancer.