Late development of intractable lymphocele after renal transplantation

A case of lymphocele occurring 7 years after kidney transplantation and leading to intractable ascites and recurrent pleural effusion is presented. Ultrasound was used extensively for diagnosis, diagnostic sampling, and monitoring of resolution and recurrence. Invasive approaches to definitive therapy, including internal drainage and ligation of lower extremity lymphatics, alleviated the local problem of a lymphocele but led to recurrent ascites and symptomatic pleural effusions. A Denver shunt,reportedly helpful in cirrhotic and oncologic patients, was successfully employed to decompress the ascites and effusion of this patient. The pathophysiology and treatment of lymphoceles and the management of peritoneovenous shunts is discussed.