LAUSR

A 65-year-old Japanese woman was admitted to our hospital with complaints of abdominal pain and a fever of 39.0 °C. Computed tomography (CT) revealed an infected lymphocele after surgery for ovarian cancer. Endoscopic ultrasoundguided lymphocele drainage (EUS-LD) was planned while avoiding free space between the colon and lymphocele using a convex EUS scope (▶Fig. 1). During the EUS procedure, VISCOCLEAR gel (Otsuka Pharmaceutical Factory, Tokushima, Japan) was injected through the accessory channel to secure the visual field without gas insufflation [1]. EUS showed an inflammatory spillover connected to the lymphocele adherent to the sigmoid colon as the puncture route. The lymphocele was punctured using a 19-gauge needle (EZ Shot 3 Plus; Olympus, Tokyo, Japan). After aspirating the lymphocele contents, a guidewire was inserted through the needle and coiled into the abscess cavity. Because of the narrow and short space, we anticipated an easy shift in the endoscope’s position. To ensure it remained stable during the procedure, we used novel drill dilator devices (Tornus ES; Olympus, Tokyo, Japan) to avoid applying unnecessary pushing force [2–4]. Thereafter, a double-pigtail plastic stent (7-Fr, 7 cm long) (Through & Pass; Gadelius, Tokyo, Japan) was placed into the lymphocele. This procedure was performed safely without complications and induced a good clinical course (▶Fig. 2, ▶Video 1). A lymphocele is a cystic mass that may occur in the retroperitoneum following a systematic pelvic and/or para-aortic lymphadenectomy. The most severe complication of a lymphocele is infection. Generally, minimally invasive methods involving catheter drainage and sclerotization tend to be popular; however, surgery remains the first option in recurring, poorly accessible or inflammaVideo 1 An effective procedure for treating lymphocele using endoscopic ultrasoundguided lymphocele drainage.