Difficult-to-treat Retroperitoneal Lymphocele Following Oblique Lumbar Interbody Fusion―A Case Report―

<p>  We report a rare and therapeutically challenging case of a retroperitoneal lymphocele that developed after oblique lumbar interbody fusion (OLIF).</p><p>  A 74-year-old woman underwent spinal canal decompression between L2 and S1, OLIF between L2 and L5, and posterior lumbar interbody fusion (PLIF) at the L5/S1 level for management of severe lumbar pain secondary to lumbar kyphosis and intermittent claudication. Follow-up magnetic resonance imaging (MRI) performed 4 months postoperatively revealed a left-sided retroperitoneal cyst (maximum diameter 11 cm). The cyst did not communicate with the ureter, and the patient was asymptomatic ; therefore, she was followed up as an outpatient. The patient developed left lower leg pain 2 years postoperatively. We performed computed tomography (CT) guided cyst puncture and drainage, and the cyst was diagnosed as a lymphocele. Continuous drainage reduced the cyst volume, and the patient’s symptoms disappeared on day 5 ; however, she was not completely cured. She underwent lymphatic embolization using lipiodol and sclerotherapy using 5% povidone-iodine, which were ineffective. Subsequently, we performed laparoscopic fenestration ; however, we observed a recurrent infected cyst. She underwent repeat sclerotherapy using 1% pyoktanin ; however, she was unresponsive to this treatment and was finally cured following continuous drainage for approximately 8 months overall.</p><p>  Lymphatic vessels tend to become thicker toward the proximal side ; therefore, postoperative lymphatic leakage may occur following operative procedures performed near large vessels. In our case, lymphocele was attributed to the hemostatic procedure performed in the vicinity of the common iliac artery. Surgeons should remain mindful of the possibility of postoperative lymphocele formation even with the use of a lumbar lateral approach, following surgical procedures performed in close proximity to the abdominal aorta or common iliac artery.</p>