Lymphocele: Symptoms, Causes, Diagnosis, And Treatment

Surgical procedures are sometimes required to assist in the treatment of certain diseases. In patients undergoing surgery in their pelvis, a number of potential risks have been identified. These complications can sometimes be serious, requiring urgent medical assistance to avoid further damage and problems. 

Lymphocele is a complication that some patients experience when undergoing surgery that affects the body’s pelvic region. Examples include prostate surgery, kidney replacement, and procedures that remove cancer. Pelvic lymphocele can lead to serious consequences.

In patients with symptomatic lymphocele, the symptoms present would make the diagnosis process easier. Unfortunately, this is not always the case. 

In this article, we will look closer at lymphocele. We consider the symptoms that may signal the condition, and we look at the potential causes. This article also looks at how the complication is diagnosed and what treatment options are available. 

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What Is Lymphocele?

Lymphocele is a surgical complication that affects the lymphatic system in the human body. The lymphatic system is responsible for carrying fluids through the body. These fluids are part of the body’s immune system. The lymphatic system plays several roles in a person’s body. It helps to reduce the risk of infection, carries waste from dead cells out of the body, and helps the body maintain adequate levels of fluids. The lymphatic system also has a role to play in the absorption process of fats in the digestive system. 

The occurrence of lymphocele is relatively low. It is mostly found among patients who undergo extensive surgery. Urological surgery in the pelvic region remains a common reason for lymphocele to develop, but the complication also seems to be relatively prevalent among patients who undergo kidney transplantation. 

Lymphocele is considered a serious complication of surgery. There are severe problems that can develop if the patient is not treated soon after the complication develops. The condition means the lymphatic fluids are filling cavities in the patient’s pelvis. As this happens, blood vessels become constricted. The lack of lymphatic fluids flowing through the body also leads to problems with the immune system

Several studies have been conducted to provide data on the occurrence of lymphocele. In one study, researchers note that the condition is considered very rare. Specific data on the clinical manifestations of lymphocele is not available. This is due to the variability in symptoms and manifestations seen among multiple patients. 

What Causes It?

There are quite a few surgical procedures that have been noted as possible causes behind lymphocele. It is important for patients to understand what type of surgical procedures can lead to lymphocele as a complication.

This allows the patient to know when they have a risk for the complication and ensures they can look out for appropriate symptoms. Early diagnosis of lymphocele can significantly improve the outcome of treatment. 

We will share a list of surgical procedures shown to contribute to the development of lymphocele below. 

  • Kidney Transplant: Patients who undergo a renal transplant have a 20% risk of developing lymphocele. The complication occurs when the surgical equipment causes damage to the lymphatic system during the procedure. If the patient experiences lymphocele as a complication, there is also a higher risk that their body would reject the new kidney. This would render renal transplantation ineffective. 

  • Lymphadenectomy: A patient who undergoes a lymphadenectomy will usually have cancer. Specific lymph nodes in the body are removed during this procedure. These lymph nodes are part of the lymphatic system. With this in mind, the patient has a relatively high risk of lymphocele when they undergo this procedure. 

  • Radical Hysterectomy: When a patient is diagnosed with cervical cancer, they may need to undergo a radical hysterectomy. The uterus is removed during this procedure. Tissue in the surrounding area may also be removed during a radical hysterectomy. In this case, there is a risk that the surgical instruments may touch the lymphatic system and cause damage. 

  • Radical Pelvic Surgery: Men with prostate cancer may need radical pelvic surgery to help stop the cancerous cells from growing and spreading. This is another surgical procedure that holds a risk for lymphocele. The surgery is also referred to as radical prostatectomy

In addition to surgery being a risk factor for lymphocele development, male patients should be aware that the condition may develop in the genitals too. In this case, the lymphocele would not be caused by surgery. Instead, vigorous masturbation is often the cause behind the condition. Intense sexual activity may also be a reason for lymphocele. 

When a max engages in an intense session of sexual activity, either through masturbation or intercourse, areas of the lymphatic system that runs close to the penis may become damaged. This would cause lymphatic fluids to leak in this area. The penis itself may be affected in such a case.

Lymph channels found inside the penis often become blocked when this happens. This is generally not a serious condition, but patients should still constantly monitor their symptoms. The condition will often go away on its own. Among patients who do experience more severe symptoms, a doctor may be able to advise on the appropriate treatment option to consider. 

Symptoms

Lymphocele formation sometimes does not cause any noticeable or obvious symptoms at a very early stage. This is known as asymptomatic lymphocele. As the lymphoceles grow, they can lead to the development of symptoms. Lymphoceles is a term used to describe multiple areas being filled with lymphatic fluid, resulting in blood flow restrictions which can cause complications. 

The lymphoceles will grow in size over time. This can sometimes be over a very short period of time, but some patients only find that the lymphocele becomes larger gradually. As the lymphoceles grow bigger, they start to press against the surrounding structures in the body. This can produce symptoms. 

Specific symptoms differ from patient to patient. The symptoms depend on where the lymphatic fluids are draining to. 

When the fluids drain toward the abdomen, then the patient will likely experience a compressed feeling in the intestines. The fluid will usually push against the large intestine. An obstruction in the intestines can develop, which may lead to serious health problems. Some patients may experience constipation when the intestines are compressed. 

In cases where the fluids drain toward the pelvis, the genitals may be affected. The patient may notice some swelling in their genital area. In some patients, there is swelling in the legs as well. 

It is not uncommon for patients to experience lower urinary tract symptoms when they have lymphocele in the pelvis. This is because the compression caused by the drained fluids can irritate the patient’s urinary tract. This causes a risk for a urinary tract infection. The patient is also likely to find that they need to urinate frequently. 

In addition to understanding these symptoms, we should also consider the possibility of complications. There are serious, potentially life-threatening complications associated with lymphocele. If the patient fails to obtain adequate treatment or detect the condition early enough, then these complications could develop:

  • Pulmonary embolism: If the lymphoceles affect the upper body, then the patient has a risk of developing pulmonary embolism. This is a condition where arteries found in the lungs become blocked. The fluids draining from the lymphatic system push against these arteries, thus causing a blockage. This complication can lead to shortness of breath, coughing, and pain in the chest. Some people experience fever, sweating, cyanosis, dizziness, and a rapid heartbeat when this complication happens. Pulmonary embolism is a life-threatening condition and requires immediate medical care. There are effective treatment options available, as long as the complication is detected early. 

  • Lymphatic Fistula Formation: A formation that consists of lymphatic fluid. This is a relatively common complication associated with untreated lymphocele. Pressure in the lymph vessels occurs, which causes channels in the system to start leaking. The capillary lymph vessels dilate. The result is destruction in the structure of the tissue. This can affect tissue in the area surrounding the lymphatic fistula formation. 

  • Venous Thrombosis: A condition that refers to the formation of a blood clot. In the majority of cases, these blood clots form in some of the deeper veins within the body. The legs are often affected by venous thrombosis. The blood clot may form when there is a constriction in the arteries. This restriction can be caused by drained lymphatic fluids. Symptoms may include shortness of breath, hemoptysis, chest pain, coughing, and anxiety. 

Men with lymphocele that affect their penis may see swelling on their genitals. The swelling may be accompanied by discomfort. The sexual function could be adversely affected while the lymphocele is present. 

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Diagnosis

Before any type of treatment can be provided, a diagnosis is needed. There are no specific manifestations that doctors are advised to look at. This is due to the wide range of cavities that may be affected by the lymphatic fluids. Thus, doctors will need to consider the symptoms reported by the patient. 

During an appointment, the doctor will ask the patient about recent surgeries. This helps the doctor determine if any surgical procedure was done that might put the patient at risk for lymphocele. Should this be the case, a physical examination will be conducted. 

The doctor will feel if there are any enlargements in the area where the patient experiences the symptoms. Enlargement may be caused by the lymphatic fluids pushing against tissue in the body. 

Additional tests are also likely to be ordered. The doctor may advise the patient to undergo imaging tests. These tests will help the doctor get a view of the patient. The tests would target the areas where symptoms are reported. 

Doctors will usually be able to see physical abnormalities on imaging tests when the patient has a lymphocele. 

Treatment Options

When a patient is diagnosed with lymphocele, the next step is to determine the best course of action to take. There are some cases where the doctor may not provide immediate treatment. This is the case with smaller lymphoceles detected in the patient’s body. A small lymphocele would generally not cause serious problems. The doctor may advise the patient to monitor their symptoms. Frequent visits to the doctor can help determine if the lymphocele is growing in size. This would mean that more lymphatic fluids are draining into the affected cavity. 

A surgical procedure will be necessary if the patient has a large lymphocele that is causing problems. During this procedure, the fluids collected in the affected cavity are drained. The procedure also allows a surgeon to fix damaged areas of the lymphatic system. This would help to stop further drainage of the fluids. 

In modern times, image guidance is used to help minimize the invasiveness of the surgery. Ultrasound is commonly used to assist in the drainage of the collected fluids. Some surgeons prefer the use of a CT scan device during the procedure. 

A few tests may be done before the procedure. This will help the surgeon better understand any specific risks that the patient faces. It also ensures the surgeon knows what to expect during the procedure and can find the most relevant process to utilize. 

Tests conducted prior to the surgery will usually require some blood from the patient. The blood is sent to a laboratory for testing. The goal is to determine if there are any functional problems with the liver or the kidneys. In cases where problems exist with either of these organs, the surgeons will need to work around these issues. A computed tomography scan, ultrasound, and magnetic resonance imaging may also be done to further test the functioning of internal organs. 

In most cases, a small sample of the fluids will be extracted before draining. The sample is collected with a small needle. The fluid sample is sent to a laboratory. Some testing is performed in the laboratory to ensure it is safe to drain the fluids. The surgeon needs to ensure there is no infection present in the fluids before the surgical procedure. An infected lymphocele may require additional treatment. 

Most patients find that they have an immediate reduction in discomfort and symptoms as fluids are drained from the cavity. 

A catheter is generally used in the process of draining the lymphocele. Catheter drainage is an effective method for removing excess fluids. Percutaneous drainage may be used. When the catheter is inserted, the lymphocele’s lining will be penetrated. This causes the lymphocele to collapse. This step is important, as this reduces the risk of the patient experiencing persistent lymphocele. 

The treatment options described above refers to lymphocele caused by a surgical procedure. As noted in the list of causes, surgery is not the only way the condition can develop. When men develop lymphocele in the penis, treatment will usually not be provided. The man will be advised to refrain from having sex for a period of six weeks. During this time, the penis can effectively recover. The doctor will also advise the man to refrain from the specific activities that led to the development of lymphocele. This may include practising safer masturbation techniques. 

Prognosis

The prognosis of lymphocele depends on how soon the condition is identified. There are some cases where the lymphoceles would be small and asymptomatic. In such a scenario, a patient may not require immediate medical treatment. If the lymphoceles grow big, however, the patient will need to undergo appropriate treatment procedures. 

When the condition is diagnosed and treated with the appropriate measures early on, then the prognosis will usually be positive. The patient will usually be able to make a swift recovery. 

There are cases where complications develop before the patient gains access to treatment. If this happens, additional treatments may be needed to help avoid further problems. Some of the complications associated with lymphocele tend to be life-threatening. This can lead to permanent damage to the body or even lead to death. With this in mind, patients are advised to be wary of the symptoms. If symptoms of lymphocele develop soon after a surgical procedure, the patient should report this to their doctor. 

Conclusion

Lymphocele is a complication that may develop following a surgical procedure in the pelvic region. The complication affects the lymphatic system. When a patient experiences lymphocele, lymphatic fluids drain into the pelvis. Blood flow construction is a common complication of lymphocele, which can cause serious medical problems in the patient. Treatments are available and need to be provided to the patient as early as possible. 

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Sources

  1. Science Direct. (2019) Lymphocele. [online] Available at: https://www.sciencedirect.com/topics/medicine-and-dentistry/lymphocele
  2. Cancer Research And Treatment. (2004) An Analysis of the Risk Factors and Management of Lymphocele after Pelvic Lymphadenectomy in Patients with Gynecologic Malignancies. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843881/
  3. Cleveland Clinic. Lymphatic System. [online] Available at: https://my.clevelandclinic.org/health/articles/21199-lymphatic-system
  4. Mayo Clinic. Pulmonary embolism. [online] Available at: 
  5. https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/symptoms-causes/syc-20354647
  6. Open Access Impact Journal. (2017) A review of the postoperative lymphatic leakage. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5620321/
  7. International Journal of Clinical and Experimental Medicine. (2015) Lymphocele: a clinical analysis of 19 cases. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4509219/

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