Sigmoid colon fistulization of an infected pelvic lymphocele after pelvic lymphadenectomy: a case report

초록

Pelvic lymphocele is a recognized complication of pelvic lymph node dissection (PLND), but fistulization to the sigmoid colon is an exceedingly rare sequela with limited management guidance. We report a 48-year-old woman who had undergone laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and PLND for cervical cancer (pT1b3N1a, FIGO IIIC) and was found during adjuvant chemotherapy to have fever, left lower-quadrant pain, and computed tomography evidence of an infected pelvic lymphocele. Percutaneous drainage identified a 2-cm sigmoid colon fistula, but its size and anatomical risk precluded interventional radiologic closure. The patient underwent segmental sigmoid resection with end-to-side anastomosis and lymphocele marsupialization. Postoperative Enterococcus faecalis infection was managed with targeted antibiotic therapy, and follow-up imaging confirmed complete resolution. Early surgical intervention should be considered when conservative and interventional approaches are impractical in symptomatic pelvic lymphocele complicated by colonic fistulization.

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