Severe Lymphorrhea Mimicking Hypovolemic Shock Following Retroperitoneal Lymphadenectomy for Endometrial Cancer: A Case Report

We present a rare case of severe lymphatic leakage resembling hypovolemic shock following retroperitoneal lymphadenectomy for endometrial cancer. A 62-year-old female developed massive lymphorrhea and chylous ascites following total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy. Immediately postoperatively, massive lymphatic leakage caused hypotension and oliguria necessitating vasopressor support. Conservative management, including fasting and octreotide, was unsuccessful. Lymphangiography with Lipiodol and subsequent embolization using N-butyl cyanoacrylate were performed but did not achieve hemodynamic stabilization. Re-laparotomy was undertaken, and indocyanine green injection into the bilateral inguinal lymph nodes, along with oral milk ingestion, enabled precise intraoperative identification of leakage sites. These were successfully ligated with adjunctive fibrin glue and oxidized cellulose. Hemodynamics rapidly improved following repair. Although most lymphatic leakages resolve conservatively, severe cases can cause life-threatening circulatory failure. This case highlights the importance of a multidisciplinary approach, including interventional radiology and surgical repair, to achieve successful outcomes.