Abstract
We report a case of primary lymphedema complicated by leaking chylous vesicles in the toe and scrotum, caused by lymphangiectasia, which was eventually managed with lymphaticovenular anastomoses after conservative treatments proved ineffective. The patient was a 25-year-old man with a 5-year history of massive swelling with chylous weeping of his right leg and scrotum. Lymphangioscintigraphy (LAS) showed dilated iliac lymph trunks causing lymph reflux. Although he was instructed in standard methods of complex therapy, it did not alleviate his symptoms. Because of the increasing frequency of cellulitis, lymphatic surgery was finally indicated. The operation consisted of lymphaticovenous anastomoses (LVA) in the ankle and groin, using a super-micro-surgical technique. After surgery, his symptoms resolved and have been controlled by self-care. Thus, early LAS to confirm the dilated iliac lymph trunks causing lymph reflux, followed by LVA might be beneficial for the management of this disease.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Noel AA, Gloviczki P, Bender CE, Whitley D, Stanson AW, Deschamps C. Treatment of symptomatic primary chylous disorders. J Vasc Surg. 2001;34(5):785–91.
Berenji GR, Iker E, Glass EC. Lymphoscintigraphic findings in chylous reflux in a lower extremity. Clin Nucl Med. 2007;32(9):725–8.
Holcomb SS. Identification and treatment of different types of lymphedema. Adv Skin Wound Care. 2006;19(2):103–8. (quiz 108–10).
Kinmonth JB, Taylor GW. Chylous Reflux. Br Med J. 1964;1(5382):529–32.
Maegawa J, Mikami T, Yamamoto Y, Hirotomi K, Kobayashi S. Lymphaticovenous shunt for the treatment of chylous reflux by subcutaneous vein grafts with valves between megalymphatics and the great saphenous vein: a case report. Microsurgery. 2010;30(7):553–6.
International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema 2009. Consensus document of the International Society of Lymphology. Lymphology. 2009;42(2):51–60.
Campisi C, Bellini C, Eretta C, et al. Diagnosis and management of primary chylous ascites. J Vasc Surg. 2006;43(6):1244–8.
Boccardo F, Bellini C, Girino M, Campisi C, Vidali F, Corazza GR. Diagnostic assessment and therapeutic approach for immunodeficiency due to chylous dysplasia: a case report. Microsurgery. 2010;30(5):401–4.
Conflict of interest
K. Suehiro and his co-authors have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Suehiro, K., Morikage, N., Murakami, M. et al. Primary lymphedema complicated by weeping chylous vesicles in the leg and scrotum: report of a case. Surg Today 42, 1100–1103 (2012). https://doi.org/10.1007/s00595-012-0193-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-012-0193-x