LAPAROSCOPIC MARSUPIALIZATION OF A LARGE RETROPERITONEAL LYMPHOCELE

Abstract

A 19-year-old man presented with a palpable abdominal mass, left supraclavicular adenopathy and intratesticular swelling of the left testis on ultrasound. Fine needle aspiration of the supraclavicular nodes revealed embryonal carcinoma. Serum a-fetoprotein and b human chorionic gonadotropin levels were elevated at 20 and 168 m./dl., respectively. The patient received 4 courses of combination chemotherapy with bleomycin, etoposide and cisplatin. Serum markers became normal (a-fetoprotein 3.6 and b human chorionic gonadotropin less than 2 m./dl.) and all metastatic lesions disappeared. The 4 3 4 3 4.5 cm. area of retroperitoneal swelling that remained was excised at left orchiectomy. Only necrotic tissue with no viable tumor was identified in both specimens. The patient complained of abdominal ache with fullness, anorexia and weight loss 2 years later. Computerized tomography (CT) of the abdomen revealed a large retroperitoneal lymphocele extending into the pelvis (fig. 1, A). Laparoscopic marsupialization was performed through a 10 mm. umbilical camera port and 2, 5 mm. ports on the right side of the abdomen. After opening the anterior wall of the lymphocele 5 l. fluid were drained. A large posterior peritoneal window was established by widely opening the anterior cyst wall (fig. 2). Abdominal CT 4 months postoperatively showed a small residual lymphocele in the upper retroperitoneum with no recurrence of the marsupialized lymphocele (fig. 1, B). DISCUSSION