Peripancreatic Lymphocele after Distal Gastrectomy

Abstract

Lymphocele occurs as a result of persistent leakage of disrupted lymphatics. Peripancreatic lymphocele is quite rare and has not yet been described in the literature. Here we report on a case of peripancreatic lymphocele in which a cystic mass was observed with a fat attenuating component using computed tomography after gastrectomy. Thus, we usually encounter lymphocele of a serous nature and with suitable radiologic findings; on ultrasound lymphocele appears as an anechoic cystic structure in a characteristic location adjacent to vessels in the parailiac region or surgical clips and may contain thin septations and debris. CT scan also reveals a hypodense cystic lesion in non-complicated cases and thick irregular enhancing wall in infected or complicated cases. On MR imaging of pelvic lymphocele appears as a lobulated cystic lesion with high signal intensity on T2-weighted images with imperceptible wall and negligible wall enhancement on contrast-enhanced T1-weighted images (2). Index termsIn our case, CT scan revealed a hypodense cystic mass in the region of the pancreatic tail after distal gastrectomy and perigastric lymphadenectomy. In view of its location, our first assumption was that the lesion was a pancreatic pseudocyst that occurred as a result of upper abdominal surgery. But, the patient had no past history of pancreatitis, no corresponding imaging findings to pancreatitis and had normal range of serum amylase. Furthermore, the hypodense cystic mass contained peripheral very low density materials, which is indicative of fat.The mass was so pathognomonic that we diagnosed the cystic mass as a lymphocele in spite of the rarity of this type of peri-2 additional sessions that were done at 48 hours intervals. The cystogram obtained after 8 days showed almost complete obliteration of the cavity (Fig. 1D), and the catheter was withdrawn without any complication. DISCUSSION