A large retroperitoneal lymphangioma successfully treated with sclerotherapy and intermittent continuous aspiration management

Introduction: The treatment options for lymphangiomas include surgery and sclerotherapy. Approximately 20% of cases are considered refractory, with surgical treatment often regarded as the primary choice. We present the successful reduction of refractory large retroperitoneal cysts, in which surgical treatment is difficult, through sclerotherapy combined with intermittent continuous suction. Case presentation: A large retroperitoneal cyst was identified in a 89-year-old woman during an evaluation for abdominal pain. The patient developed pulmonary thromboembolism and stasis dermatitis in the right lower leg, leading to a decline in her activities of daily living. Fluid drainage and puncture tests were performed, with the initial drainage yielding 1,432 mL. The cell fraction of the puncture fluid confirmed the presence of lymphatic fluid, establishing a diagnosis of lymphangioma. However, recurrence was observed 2 weeks later, accompanied by abdominal distension. Sclerotherapy was performed using foam created from a mixture of 3% polidocanol and air in a 1:4 ratio. The effect was insufficient, and despite a total of eight puncture drainages and three subsequent sclerotherapy sessions, there was no observable reduction in size. Finally, sclerotherapy with intermittent continuous suction was performed under inpatient care. Over the course of 8 days, the daily drainage volume significantly decreased from 115 mL to 15 mL. No recurrence was observed. Conclusion: Sclerotherapy with intermittent continuous suction management is a useful and feasible treatment option for refractory large retroperitoneal cysts, for which surgical treatment is difficult. Keywords Lymphangioma, Retroperitoneal cyst, Sclerotherapy, Polidocanol