Infected Pelvic Lymphocele Complicated by Sigmoid Colon Fistula: A Rare Surgical Case Report

초록

Lymphocele is one of the common complications that can occur after pelvic lymph node dissection, with an incidence rate ranging from approximately 16% to as high as 60%, depending on the surgeon. Most lymphoceles are asymptomatic and may resolve spontaneously; however, 5?10% can become complicated. The occurrence of a fistula between an infected lymphocele and the sigmoid colon is extremely rare. Here, we present a case of infected lymphocele complicated by sigmoid colon fistula, which required surgical management. A 48-year-old female patient was referred to colorectal department from the gynecology service for further evaluation. She had previously undergone laparoscopic hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection for cervical cancer. The patient had completed four cycles of adjuvant chemotherapy and was scheduled for a fifth cycle. Three months postoperatively, she was scheduled for the fifth cycle of chemotherapy; however, she presented with left lower abdominal pain and fever prior to admission. On admission, physical examination revealed a temperature of 38.5°C. Chemotherapy was withheld, and antibiotics were initiated. Abdominal CT demonstrated progression of the pelvic lymphocele with findings suspicious for infection and possible fistula formation, prompting surgical consultation. On examination, localized tenderness was noted in the left lower abdomen. Laboratory results showed a white blood cell count of 9,330/μL (79.6% neutrophils) and a C-reactive protein level of 12.47 mg/dL. For both diagnostic and therapeutic purposes, percutaneous drainage of the lymphocele was requested from the Department of Interventional Radiology. During the procedure, fluoroscopic contrast injection demonstrated extensive leakage into both the proximal and distal sigmoid colon, confirming the presence of a fistulous connection.