Two Cases of Venous Thromboembolism Caused by Pelvic Lymphocele after Rectal Cancer Surgery with Lateral Node Dissection

Takayuki Ogino, Masayuki Ohue, Shingo Noura, Terumasa Yamada, Isao Miyashiro, Masahiko Yano, Hiroaki Ohigashi, Yo Sasaki, Osamu Ishikawa and Shingi Imaoka

Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases

We report two cases of venous thromboembolism caused by pelvic lymphocele after rectal cancer surgery with lateral node dissection. Case1: A 44-year-old man hospitalized for anorectal cancer 7 cm from the anal verge arising from an anal fistula was found in biopsy specimens to have signet-ring cell carcinoma. After preoperative chemoradiation, he underwent abdominoperineal resection with lateral node dissection. On postoperative day (POD) 20, he suffered acute pain and edema of the right lower extremity. CT showed deep vein thrombosis due to compression of the right external iliac vein by a 10.8 cm wide pelvic lymphocele. After lymphocele drainage and anticoagulation therapy, he recovered. Case2: A 54-year-old woman hospitalized for rectal cancer and massive lateral node metastases, developed pulmonary embolism with bilateral deep vein thrombosis caused by pelvic lymphoceles on POD 42 after abdominoperineal resection with lateral node dissection following preoperative chemoradiation. After lymphocele drainage and anticoagulation therapy following inferior vena cava filter placement, she recovered. These two patients remain alive and disease-free 1 year after surgery.

Key words
anorectal cancer, lymphocele, venous thromboembolism

Reprint requests
Takayuki Ogino Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511 JAPAN

Accepted
May 30, 2007

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