A Case of Traumatic Retroperitoneal Chylous Lymphocyst

We report a patient with a retroperitoneal chylous lymphocyst developing after a blunt abdominal trauma. A 48-year -old woman fell down a 1-meter-high stepladder and struck her right abdomen. Three days after the fall, the abdominal swelling had gradually exacerbated, so the patient consulted our de...

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Published inNihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 26; no. 3; pp. 451 - 454
Main Authors Tsukui, Taku, Tajiri, Takashi, Matsuhisa, Takeshi, Okihama, Yuji, Kimura, Yu, Matsuda, Takeshi, Egami, Kaku
Format Journal Article
LanguageJapanese
Published Japanese Society for Abdominal Emergency Medicine 2006
日本腹部救急医学会
Subjects
リンパ嚢腫
乳糜嚢胞
外傷
後腹膜
Online AccessGet full text
ISSN1340-2242
1882-4781
DOI10.11231/jaem1993.26.451

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Abstract We report a patient with a retroperitoneal chylous lymphocyst developing after a blunt abdominal trauma. A 48-year -old woman fell down a 1-meter-high stepladder and struck her right abdomen. Three days after the fall, the abdominal swelling had gradually exacerbated, so the patient consulted our department. Abdominal echography and CT studies revealed a giant cyst in the right retroperitoneum; the patient was immediately admitted. Yellowish white chyle (2, 855ml) was collected by a percutaneous puncture of the cyst, and scintigraphy of the lymph vessel confirmed uptake, which was consistent with the cyst site. These results suggested a traumatic retroperitoneal chylous lymphocyst (lymphorrhea related to lymph vessel injury). Oral ingestion was restricted, and a percutaneous drain was inserted. The features of the drained fluid changed from chyle to transparent lymph. Outflow from the drain completely stopped 29 days after admission, and imaging confirmed the disappearance of the cyst. The drain was removed 33 days after admission. The patients was discharged from hospital, and the cyst did not recur.
AbstractList We report a patient with a retroperitoneal chylous lymphocyst developing after a blunt abdominal trauma. A 48-year -old woman fell down a 1-meter-high stepladder and struck her right abdomen. Three days after the fall, the abdominal swelling had gradually exacerbated, so the patient consulted our department. Abdominal echography and CT studies revealed a giant cyst in the right retroperitoneum; the patient was immediately admitted. Yellowish white chyle (2, 855ml) was collected by a percutaneous puncture of the cyst, and scintigraphy of the lymph vessel confirmed uptake, which was consistent with the cyst site. These results suggested a traumatic retroperitoneal chylous lymphocyst (lymphorrhea related to lymph vessel injury). Oral ingestion was restricted, and a percutaneous drain was inserted. The features of the drained fluid changed from chyle to transparent lymph. Outflow from the drain completely stopped 29 days after admission, and imaging confirmed the disappearance of the cyst. The drain was removed 33 days after admission. The patients was discharged from hospital, and the cyst did not recur. 鈍的腹部外傷後に発症した, 後腹膜乳魔性リンパ嚢腫の1例を経験したので報告する. 症例は48歳の女性で, 約1mの高さの脚立から転倒し右側腹部を強打した. その後, 約3日間放置していたところ, 腹部膨満感が次第に増強し, 当科を受診した. 腹部超意波およびCT検査で, 右後腹膜に巨大嚢胞を認め, 緊急入院となった. 経皮的に嚢胞の穿刺を行い黄白色の乳糜液 (2, 855ml) が採取でき, リンパ管シンチ検査にて嚢胞部に一致して集積像を確認した. 以上より, 外傷性後腹膜乳靡性リンパ嚢腫の診断を得た. 経口食摂取を制限して持続的に経皮的ドレナージを留置したところ, 排液の性状が乳糜液から透明のリンパ液に変化し, 入院29日目には排液の流出が完全に止まり, 画像上も嚢胞の消失が確認された. 入院33日目にドレーンを抜去し, 退院後も嚢胞の再発は認められていない.
We report a patient with a retroperitoneal chylous lymphocyst developing after a blunt abdominal trauma. A 48-year -old woman fell down a 1-meter-high stepladder and struck her right abdomen. Three days after the fall, the abdominal swelling had gradually exacerbated, so the patient consulted our department. Abdominal echography and CT studies revealed a giant cyst in the right retroperitoneum; the patient was immediately admitted. Yellowish white chyle (2, 855ml) was collected by a percutaneous puncture of the cyst, and scintigraphy of the lymph vessel confirmed uptake, which was consistent with the cyst site. These results suggested a traumatic retroperitoneal chylous lymphocyst (lymphorrhea related to lymph vessel injury). Oral ingestion was restricted, and a percutaneous drain was inserted. The features of the drained fluid changed from chyle to transparent lymph. Outflow from the drain completely stopped 29 days after admission, and imaging confirmed the disappearance of the cyst. The drain was removed 33 days after admission. The patients was discharged from hospital, and the cyst did not recur.
Author Matsuhisa, Takeshi
Tajiri, Takashi
Okihama, Yuji
Kimura, Yu
Egami, Kaku
Matsuda, Takeshi
Tsukui, Taku
Author_FL 木村 祐
松田 健
津久 井拓
田尻 孝
松久 威史
沖浜 裕司
江上 格
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Nihon Fukubu Kyukyu Igakkai Zasshi
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日本腹部救急医学会
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References 11) Meinke AH, Estes NC, Ernst CB: Chylous ascites following abdominal aortic aneurysmectomy: Management with total parenteral hyperalimentation. Ann Surg 1979; 190: 631-633.
4) 落合正宏, 内村正史, 村岡正朗, ほか: 急性虫垂炎様症状で発症した後腹膜嚢腫状リンパ管腫の2最近10年間の報告例を中心とした文献的考察. 日臨外医会誌 19-6; 57: 1226-1230.
6) 小松永二, 石塚直樹, 濱谷弘康, ほか: 急性腹症を呈した後腹膜膿庖性リンパ管腫の1例. 日臨外会誌1998; 59: 3176-3179.
10) Smith RJH, Burke DK, Sato Y, et al: OK-432 therapy for lymphangioma. Arch Otolaryngol Head Neck Surg 1996; 122: 1195-1199.
3) Weiss SW, Goldblum JR: Tumors of lymph vessels. Soft Tissue Tumors, 4th edition. St. Louis: Mosby, 2001: 955-983.
5) 沢井博純, 中村司, 林周作, ほか: 成人後腹膜リンパ管腫の1例. 日臨外医会誌 19-5; 56: 2215-2219.
1) 鈴木衛, 上山武史, 明元克司, ほか: 腹部大動脈手術後のリンパ系合併症傍大動脈リンパ嚢胞と乳糜腹水. 日心外会誌1992; 21: 99103.
2) 荻田修平, 岩井直躬: リンパ管腫. 小児外科1993; 25: 4-53.
7) 大塚幸雄: 後腹膜嚢腫. 別冊日本臨床 1996: 313-315.
9) 小笠原豊, 万代康弘, 大谷 順, ほか: 後腹膜乳び嚢腫の1例. 広島医学 2002; 55: 331-333.
8) 山口千美, 冨田京一, 金子裕憲, ほか: リンパ管造影にて診断可能であった後腹膜嚢腫状リンパ管腫の1例. 泌外1988; 1: 363-368.
References_xml – reference: 3) Weiss SW, Goldblum JR: Tumors of lymph vessels. Soft Tissue Tumors, 4th edition. St. Louis: Mosby, 2001: 955-983.
– reference: 2) 荻田修平, 岩井直躬: リンパ管腫. 小児外科1993; 25: 4-53.
– reference: 9) 小笠原豊, 万代康弘, 大谷 順, ほか: 後腹膜乳び嚢腫の1例. 広島医学 2002; 55: 331-333.
– reference: 4) 落合正宏, 内村正史, 村岡正朗, ほか: 急性虫垂炎様症状で発症した後腹膜嚢腫状リンパ管腫の2最近10年間の報告例を中心とした文献的考察. 日臨外医会誌 19-6; 57: 1226-1230.
– reference: 10) Smith RJH, Burke DK, Sato Y, et al: OK-432 therapy for lymphangioma. Arch Otolaryngol Head Neck Surg 1996; 122: 1195-1199.
– reference: 1) 鈴木衛, 上山武史, 明元克司, ほか: 腹部大動脈手術後のリンパ系合併症傍大動脈リンパ嚢胞と乳糜腹水. 日心外会誌1992; 21: 99103.
– reference: 7) 大塚幸雄: 後腹膜嚢腫. 別冊日本臨床 1996: 313-315.
– reference: 5) 沢井博純, 中村司, 林周作, ほか: 成人後腹膜リンパ管腫の1例. 日臨外医会誌 19-5; 56: 2215-2219.
– reference: 8) 山口千美, 冨田京一, 金子裕憲, ほか: リンパ管造影にて診断可能であった後腹膜嚢腫状リンパ管腫の1例. 泌外1988; 1: 363-368.
– reference: 6) 小松永二, 石塚直樹, 濱谷弘康, ほか: 急性腹症を呈した後腹膜膿庖性リンパ管腫の1例. 日臨外会誌1998; 59: 3176-3179.
– reference: 11) Meinke AH, Estes NC, Ernst CB: Chylous ascites following abdominal aortic aneurysmectomy: Management with total parenteral hyperalimentation. Ann Surg 1979; 190: 631-633.
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Snippet We report a patient with a retroperitoneal chylous lymphocyst developing after a blunt abdominal trauma. A 48-year -old woman fell down a 1-meter-high...
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StartPage 451
SubjectTerms リンパ嚢腫
乳糜嚢胞
外傷
後腹膜
Title A Case of Traumatic Retroperitoneal Chylous Lymphocyst
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