Refractory Hepatic Lymphorrhea: Percutaneous Transhepatic Lymphangiography and Embolization with n-Butyl-2-Cyanoacrylate Glue

Hasegawa, Tetsuya; Tsuboi, Masahiro; Fukushima, Kei; Yukawa, Tomoki

doi:10.1007/s00270-021-02802-8

Cited by 9 publications

(10 citation statements)

References 9 publications

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“…All these cases recovered clinically after the 1st or 2nd embolization, suggesting that the method is very effective. However, the lymph vessel could not be delineated at the 1st PTL in four cases, including the current case [ 26 , 27 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Potential complications of PTLE include hepatic dysfunction [ 26 ], but there have only been two reports of mild abdominal pain [ 30 ] and slight intraabdominal hemorrhage [ 27 ] to date. Although there is a concern about possible embolism in other organs, there have been no reports of this occurring after PTLE for hepatic lymphorrhea after surgery for a digestive tract cancer.…”

Section: Discussionmentioning

confidence: 99%

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Successful percutaneous transhepatic lymphangiography and embolization for intractable hepatic lymphorrhea after laparoscopic distal gastrectomy: a case report

et al. 2023

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Background Hepatic lymphorrhea is a rare and serious complication of surgery for digestive tract cancers and is thought to occur as a result of lymph node dissection of the hepatoduodenal ligament. This complication results in the accumulation of lymphatic fluid, which may in turn lead to nutritional disorders, immune deficiency, and circulation insufficiency. However, there is currently no standard strategy for treating this condition. Case presentation A 49-year-old woman with alcoholic liver damage underwent laparoscopic distal gastrectomy with lymph node dissection for early gastric cancer. Abundant ascites persisted postoperatively, and the fluid was suspected to indicate hepatic lymphorrhea. The patient was re-admitted on postoperative day 26 due to the onset of a brain infarction caused by dehydration. Various conservative treatments for hepatic lymphorrhea were ineffective. She underwent percutaneous transhepatic lymphangiography and embolization on postoperative day 81, with obvious effect. Computed tomography images demonstrated complete disappearance of ascites. Conclusions Postoperative hepatic lymphorrhea is a rare and serious complication of radical surgery for digestive tract cancers. The current case suggests that percutaneous transhepatic lymphangiography and embolization may be a rational treatment option when conservative treatments fail.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Successful percutaneous transhepatic lymphangiography and embolization for intractable hepatic lymphorrhea after laparoscopic distal gastrectomy: a case report

et al. 2023

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“…Although initially thought to be caused by malignant tumors in the majority of cases (85%), 137 chylolymphatic ascites, for example, is now recognized as a more complex pathology with only 25% attributed to malignancy in contemporary reports 138 . Causes can be nonportal due to obstruction of central lymphatic run-off (iatrogenic, malignant, infectious, congenital) or due to local alterations (eg, congenital or traumatic) of retroperitoneal, hepatic, or mesenteric lymphatics 30,54,139–141 . However, also increased portal venous pressure with increased hepatic lymph production can ultimately result in diffuse lymphatic fluid leakage into the abdomen 9 …”

Section: Lymphatic Diseases Overviewmentioning

confidence: 99%

Back to the Future II—A Comprehensive Update on the Rapidly Evolving Field of Lymphatic Imaging and Interventions

Pieper

2023

Invest Radiol

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Lymphatic imaging and interventional therapies of disorders affecting the lymphatic vascular system have evolved rapidly in recent years. Although x-ray lymphangiography had been all but replaced by the advent of cross-sectional imaging and the scientific focus shifted to lymph node imaging (eg, for detection of metastatic disease), interest in lymph vessel imaging was rekindled by the introduction of lymphatic interventional treatments in the late 1990s. Although x-ray lymphangiography is still the mainstay imaging technique to guide interventional procedures, several other, often less invasive, techniques have been developed more recently to evaluate the lymphatic vascular system and associated pathologies. Especially the introduction of magnetic resonance, and even more recently computed tomography, lymphangiography with water-soluble iodinated contrast agent has furthered our understanding of complex pathophysiological backgrounds of lymphatic diseases. This has led to an improvement of treatment approaches, especially of nontraumatic disorders caused by lymphatic flow abnormalities including plastic bronchitis, protein-losing enteropathy, and nontraumatic chylolymphatic leakages. The therapeutic armamentarium has also constantly grown and diversified in recent years with the introduction of more complex catheter-based and interstitial embolization techniques, lymph vessel stenting, lymphovenous anastomoses, as well as (targeted) medical treatment options. The aim of this article is to review the relevant spectrum of lymphatic disorders with currently available radiological imaging and interventional techniques, as well as the application of these methods in specific, individual clinical situations.

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“…So, various lymphatic interventions were mainly carried out in imaginary scenarios of different PLLs. Finally, there are rarely used lymphatic interventions that we have not mentioned in this review, such as retrograde thoracic duct embolization, transhepatic lymphatic embolization, etc., which merit further research in animals (Mittleider et al 2008;Hasegawa et al 2021). In addition, translymphatic and intranodal MRLs are also worth exploring.…”

Section: To Recapitulate Key Anatomical and Histopathologicalmentioning

confidence: 99%

Standardizing lymphangiography and lymphatic interventions: a preclinical in vivo approach with detailed procedural steps

et al. 2023

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Purpose To present a preclinical in vivo approach for standardization and training of lymphangiography and lymphatic interventions using a pictorial review. Materials and methods Different lipiodol- and gadolinium-based lymphangiography and lymphatic interventions were performed in twelve (12) landrace pigs with a mean bodyweight of 34 ± 2 kg using various imaging and guiding modalities, similar to the procedures used in humans. The techniques used were explicitly introduced and illustrated. The potential applications of each technique in preclinical training were also discussed. Results By applying visual, ultrasonography, fluoroscopy, CT, cone-beam CT, and/or MRI examination or guidance, a total of eleven techniques were successfully implemented in twelve pigs. The presented techniques include inguinal postoperative lymphatic leakage (PLL) establishment, interstitial dye test, five types of lymphangiography [incl. lipiodol-based translymphatic lymphangiography (TL), lipiodol-based percutaneous intranodal lymphangiography (INL), lipiodol-based laparotomic INL, lipiodol-based interstitial lymphangiography, and interstitial magnetic resonance lymphangiography (MRL)], and four types of percutaneous interventions in the treatment of PLL [incl. thoracic duct embolization (TDE), intranodal embolization (INE), afferent lymphatic vessel sclerotherapy (ALVS), and afferent lymphatic vessel embolization (ALVE)]. Conclusion This study provides a valuable resource for inexperienced interventional radiologists to undergo the preclinical training in lymphangiography and lymphatic interventions using healthy pig models.

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Refractory Hepatic Lymphorrhea: Percutaneous Transhepatic Lymphangiography and Embolization with n-Butyl-2-Cyanoacrylate Glue

Cited by 9 publications

References 9 publications

Successful percutaneous transhepatic lymphangiography and embolization for intractable hepatic lymphorrhea after laparoscopic distal gastrectomy: a case report

Successful percutaneous transhepatic lymphangiography and embolization for intractable hepatic lymphorrhea after laparoscopic distal gastrectomy: a case report

Back to the Future II—A Comprehensive Update on the Rapidly Evolving Field of Lymphatic Imaging and Interventions

Standardizing lymphangiography and lymphatic interventions: a preclinical in vivo approach with detailed procedural steps

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