Lymph is the fluid circulating in the lymphatic system. It is formed from the collection of fluid present in tissue spaces by the lymph capillaries (small lymphatic vessels). Lymphatic fluid collection in a cavity or sac in the body is called as a lymphocele. A lymphocele tends not be lined by any membrane, such as an epithelial lining. It is believed to result from damage to lymphatic system, usually following trauma or surgery. Although it can arise spontaneously, it does so only very rarely.
A lymphocele often does not cause any symptoms. That is especially the case if lymphocele is small. If the lymphocele is large, it can cause symptoms by pressing on adjacent structures. For instance, if the lymphocele is in the abdomen or pelvis, it can cause abdominal fullness and pain, increased urinary frequency, constipation, and edema of genitals or even legs. A lymphocele is diagnosed with the help of a CT scan or ultrasound.
Causes Of Lymphocele
A lymphocele usually occurs as a complication following surgery. This is especially the case if the surgery is done over a large area, and thus increasing the chances of causing injury to the lymphatic system. Here are some common reasons for the occurrence of a lymphocele.
Lymphocele is quite a common complication following kidney transplantation. The incidence can be anywhere between 1% and 15%. The complication can manifest within 34 weeks of the surgery or longer.
Its incidence is more in patients having diabetic nephropathy (pathology of kidney due to diabetes), congenital malformations in urinary tract, and glomerulopathy (inflammation of kidney) and other inflammatory diseases, and following high-voltage radiotherapy.
Sometimes the uterus has to be removed totally. Such an operation is called radical hysterectomy. Indication for such an operation is usually cancer of the uterus. One of the complications of radical hysterectomy is a lymphocele.
The site of its occurrence is the pelvis and/or behind the peritoneum (the lining of the abdominal cavity). The lymphocele can vary in size, sometimes being as large as 10 cm in diameter. Placement of a drain after the operation decreases the chances of lymphocele formation.
In certain cancers of the pelvic organs, such as that of the uterus in women or the prostate in men, the lymph nodes in the pelvic region need to be dissected and removed (lymphadenectomy). The regional lymph nodes tend to get involved in advanced stages of such cancers.
When such lymphadenectomy is done, the lymphatic vessels in the region can get injured, leading to a local lymphocele. Their incidence following radical lymphadenectomy is up to 30%.
Trauma Or Surgery In Thoracic Or Neck Region
In some cases, a lymphocele can occur within the chest cavity. This is usually due to an injury to the thoracic duct, which is the major lymphatic vessel that carries the lymph back from the other regions of the body and ultimately drains into a major vein.
Sometimes, such an injury can be caused by a surgeon operating in that region. These surgeries can include surgeries on the breast, in the axilla (armpit), and in the neck.
Other Causes Of Lymphocele
Infection or collection of blood near the site of an injury can lead to the formation of a lymphocele. They can also occur after radiation therapy given prior to a surgery.
A lymphocele can also occur following surgery for ovarian cancer. The incidence in such cases can be as high as 20%. It can develop within 2-4 months following surgery.
Photo Credit: http://www.ruh.nhs.uk/patients/Urology/treatments/prostatectomy/index.asp
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