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Retroperitoneal Lymphocele After Anterior Spinal Surgery

2008; Lippincott Williams & Wilkins; Volume: 33; Issue: 18 Linguagem: Inglês

10.1097/brs.0b013e31817c6ced

1528-1159

Alpesh A. Patel, W. Ryan Spiker, Michael D. Daubs, Darrel S. Brodke, Ivan Cheng, Robert E. Glasgow,

Lymphatic Disorders and Treatments

In Brief Study Design. Case report; Review of Literature. Objective. To present an uncommon complication after anterior lumbar surgery as well as a treatment option and a review of the literature. Summary of Background Data. A number of complications have been reported after anterior lumbar surgery. Common complications include vascular, ureteral, and neurologic injuries. The development of a retroperitoneal lymphocele has been previously been described, but details regarding evaluation, diagnosis, and treatment options are lacking in the literature. Methods. The case of a single patient with a postoperative retroperitoneal lymphocele was identified and retrospectively reviewed. Permission was obtained from the patient to review and publish this information. A review of literature on lymphoceles and anterior lumbar complications was also performed using PubMed and Ovid databases. Results. A 76-year-old woman underwent anterior interbody fusion from L2–L3–L4–L5, followed by posterior T11–L5 fusion for degenerative scoliosis and spinal stenosis. Six weeks after surgery, she presented with severe abdominal pain, nausea, and emesis. Examination revealed a retroperitoneal lymphocele, which was confirmed after aspiration. The patient was treated with a laparoscopic marsupialization procedure without recurrence. At 12 months, the patient had no further abdominal symptoms, noted improvements in back and leg pain scores, and had stable radiographic findings. Conclusion. Retroperitoneal lymphocele is a rare complication after anterior lumbar interbody fusion. The different diagnosis should include infectious abscess, ureteral injury with urinoma, pancreatic injury with pseudocyst formation, and spinal fluid leak with pseudomeningocele. Diagnosis can be guided by serum and cyst fluid analysis. Although treatment options exist, surgical treatment may provide the most reliable results. Development of a lymphocele is an uncommon complication of anterior lumbar surgery. Symptoms may be nonspecific, and therefore diagnosis is based on serum and cyst fluid analysis. Differential diagnosis includes ureteral injury, spinal fluid leak, pancreatic injury, or infection. Surgical treatment may provide better outcomes than nonoperative options.