PMC6068077_01
Abdominal computed tomography showing significant ascites.
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Abdominal computed tomography (CT) showed a large amount of ascites (Fig. 1).
a. Laparoscopic imaging showing a large amount of whitish chylous ascites. b. A white stream of leaking chyle was visualized at the upper part of the inferior mesenteric artery.
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On laparoscopic exploration, a large amount of whitish ascites was observed (Fig. 2a). The lymphatic leakage site was detected at the upper part of the inferior mesenteric artery (IMA) which was the site of the previous lymphadenectomy because a white stream of leaking chyle was visualized (Fig. 2b).
To reconfirm the leakage site, 0.5 mL of indocyanine green (2.5 mg/dL) was injected around the inferior mesenteric artery.
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Furthermore, we injected 0.5 mL of ICG (2.5 mg/dL) around the IMA (Fig. 3), and we reconfirmed the leakage site by checking ICG leakage on fluorescence imaging using an infrared camera system (Fig. 4a).
a. After indocyanine green injection, fluorescence imaging using an infrared camera system revealed the leakage site (arrow). b. Lymphatic flow was noted after injecting other sites of the lymphadenectomy with indocyanine green. However, these sites did not show additional lymphatic leakage.
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We injected the ICG into the other sites of the lymphadenectomy and identified the lymphatic flow, but there was no other lymphatic leakage (Fig. 4b).
a. The lymphatic leakage site after ligation (arrow). b. Fibrin glue was sprayed over the entire ligated area (arrow).
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Thereafter, we ligated the lymphatic leakage site (Fig. 5a) and fibrin glue was sprayed over the entire ligation area (Fig. 5b).