[A Case Report of Therapeutic Lymphangiography for Lymphorrhea after Sigmoid Colon Cancer Surgery]

The patient was a man in his 70s. He underwent laparoscopic sigmoidectomy+D3 lymph node dissection for sigmoid colon cancer(cT3N0M0, cStage Ⅱa). The day after surgery, the amount of ascites was 600 mL/day. The amount of ascites continued to increase. After he started eating, the ascites turned white, so we diagnosed him as having lymphorrhea. We performed conservative treatment with total parenteral nutrition. However, there was no improvement. Therefore, 2 weeks after surgery, we performed lymphangiography using lipiodol. For lymphangiography, 10 mL of lipiodol was injected under ultrasound guidance from the left inguinal lymph node. Four mL was also injected from the right inguinal lymph node. The injected lipiodol traveled through the lymphatic vessels along the abdominal aorta from the common iliac artery. Finally, leakage was observed near the root of the inferior mesenteric artery(IMA). The amount of drainage increased to 1,900 mL the day after the contrast examination, but decreased to 50 mL 4 days after the examination. There was no increase in the amount of drainage thereafter, and even after oral intake was started, there was no increase in the drainage or change in its properties. Abdominal CT scan also showed no accumulation of ascites.