Lymphocele infection is a rare complication after radical prostatectomy and pelvic lymph node dissection (PLND). Here, we present a case of lymphocele infection that extended to the leg two months after robot-assisted laparoscopic radical prostatectomy and PLND. The patient was a 60-year-old man whose chief complaints were fever, chills, and right thigh pain. Computed tomography showed infected lymphocele with right thigh abscess. After percutaneous drainage and intravenous antibiotics, the infection and right thigh abscess were resolved.
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Case ReportA lymphocele is a collection of lymphatic fluid within the body that is not bordered by epithelial lining; this occurs as a consequence of surgical dissection of afferent lymphatic vessels. After radical prostatectomy and pelvic lymph node dissection (PLND), incidence of symptomatic lymphocele is rare; however, asymptomatic lymphocele occurs in up to 61% of cases [1]. Symptomatic lymphoceles present infection, deep vein thrombosis (DVT), pulmonary embolism, and/or leg edema, with infection being the most common concurrent presentation [2].Here, we present a case of infected lymphocele that extended to the leg after robot-assisted radical prostatectomy (RARP) and PLND.
CASE REPORTA 60-year-old man referred to our hospital presented fever, chills, myalgia, and right thigh pain. He underwent RARP and PLND at a different hospital two months prior to his referral. He experienced myalgia and right thigh pain for four days and took amoxicillin for two days. However, fever and right thigh pain persisted, causing him to visit our emergency department. His blood pressure was 130/80 mmHg, body temperature was 37.5 o C, pulse rate was 110 beats/minute, and respiratory rate was 26 breaths/minute. Physical examination revealed right thigh swelling, heating sense, and tenderness. On laboratory examination, his white blood cell count was 19,700×10 3 /l (neutrophils, 89%), erythrocyte sedimentation rate was 69 mg/h, and C-reactive protein level was 217.4 mg/L. Urine analysis was unremarkable. Abdominopelvic computed tomography (CT) scan showed a cystic mass measuring 8.5×5.4 cm with a thick capsule in the right pelvic cavity, and another cystic mass measuring 8.3×4.6 cm with heterogeneous enhancement in the right thigh (Fig. 1). He underwent percutaneous drainage of the right infected lymphocele and was administered with intravenous antibiotics. Right thigh abscess decreased in size after percutaneous drainage (Fig. 2); pus culture revealed Staphylococcus aureus. Ten days after puncture, the lymphocele