Lower limb
lymphedema and an accompanying lymphatic
fistula (lymphorrhea) occur as complications after
gynecologic surgery to treat
cancer. Herein, we report the case of a 68-year-old woman who underwent resection and
radiotherapy because of
uterine cervical cancer (stage 2a) 20 years previously. Left lower limb and pudendal
lymphedema and continuous lymphorrhea developed soon after surgery.
Conservative treatment was administered; however, the
edema increased, and a pudendal lymphatic
fistula and
cellulitis developed repeatedly. Lymphovascular anastomosis (LVA) and lymph vessel
ligation were performed after preoperative evaluation via lymphoscintigraphy and
indocyanine green (ICG) lymphography. A
radioisotope injected into the first interdigit pedal region flowed into the pudendal region via the inguinal lymph nodes at preoperative lymphoscintigraphy. Linear patterns were observed up to the half level of the crus, and stardust patterns occurred over the lower abdominal and pudendal regions at ICG lymphography. During surgery, ICG lymphography was also used to identify the site of the
fistula. With the patient under
local anesthesia, LVA was applied in the half crus and left inguinal regions, followed by
ligation and division of lymph vessels flowing into the
fistula. The region around the
fistula was excised as a 1 × 3-cm tissue block. As of 5 months after surgery, no recurrence of lymphatic
fistula or exacerbation of
lymphedema has occurred. This case shows the effectiveness of preoperative ICG lymphography and lymphoscintigraphy followed by treatment via lymph vessel
ligation and LVA for curative resolution of a lymphatic
fistula.