case_images: PMC10798289_01
case_images: Preoperative findings. Abdominal distension is observed (A). Contrast-enhanced CT shows a large amount of ascites (B). The schema indicates that the lymphadenectomy resulted in a large amount of lymphatic fluid leakage and ascites accumulation (C). Lymphoscintigraphy or SPECT reveals leakage of the radioisotope into the peritoneal cavity. No secondary lymphedema is observed in either lower extremity (D). The arrow points to the leaked radioisotope (E).
case_images: ICRP_A_2304617_F0001_C.jpg
case_images: PMC10798289_01_ICRP_A_2304617_F0001_C.jpg
case_images: F0001
case_images: One month after surgery, the patient complained of dyspnea and abdominal distension (Figure 1(A)). Contrast-enhanced CT showed a large amount of ascites (Figure 1(B)). It was thought that lymphatic leakage due to lymphadenectomy caused this accumulation of ascites (Figure 1(C)). Lymphoscintigraphy with 99mTc showed that the radioisotope reached the peritoneal cavity as early as 5 min after injection (Figure 1(D)), followed by findings of leakage of the radioisotope into the peritoneal cavity. Single photon emission computed tomography (SPECT) also showed leakage of the radioisotope into the peritoneal cavity (Figure 1(E)).
case_images: Intraoperative findings. Three lymphatic vessels and three veins are anastomosed in each of the right (A) and left (C) groin regions. The circles indicate the anastomoses. The triangle indicates the great saphenous vein (A). The tetragon indicates the accessory saphenous vein (C). The schema indicates the LVA on the right (B) and left (D) sides.
case_images: ICRP_A_2304617_F0002_C.jpg
case_images: PMC10798289_01_ICRP_A_2304617_F0002_C.jpg
case_images: F0002
case_images: Three afferent lymphatic vessels confluent with the lymph node were each anastomosed end-to-end with branches of the great saphenous vein (Figure 2(A,B)). In addition, another afferent lymphatic vessel was anastomosed end-to-side to the main trunk of the accessory saphenous vein (Figure 2(C,D)).
case_images: Postoperative findings. Abdominal distension disappears after LVA (A). Contrast-enhanced CT shows no evidence of ascites effusion (B). Lymphoscintigraphy (C) or SPECT (D) shows no evidence of radioisotope leakage into the peritoneal cavity. No secondary lymphedema is observed in either lower extremity. However, there is delayed lymphatic flow in the left lower extremity. The schema indicates that LVA reduced the amount of lymphatic fluid leaking into the abdominal cavity (E).
case_images: ICRP_A_2304617_F0003_C.jpg
case_images: PMC10798289_01_ICRP_A_2304617_F0003_C.jpg
case_images: F0003
case_images: One year and two months after LVA, the abdominal distension had disappeared (Figure 3(A)) and contrast-enhanced CT showed no evidence of ascites effusion (Figure 3(B)). There was also no evidence of radioisotope leakage into the peritoneal cavity on lymphoscintigraphy (Figure 3(C)) or SPECT (Figure 3(D)).