Case Report

Bleomycin Sclerotherapy for Severe Symptomatic and Persistent Pelvic Lymphocele

Table 1

Studies in treatment modalities for pelvic lymphoceles.

References Treatment modalitySclerosing agentSuccess rateSide effects/complications

Surgical treatment
Radosa et al., 2013 [27]132Laparoscopic drainageNA93%Intraoperative 9.8%
Postoperative 5.9%
Khoder et al., 2012 [28]105Laparoscopic drainageNA97%Not mentioned/unknown
Hsu et al., 2000 [57]81Laparoscopic drainageNA94%Intraoperative (5%):
(i) laryngospasm ( )
(ii) inferior epigastric artery injury ( )
(iii) mild renal capsule hematoma ( )
(iv) bladder injury ( )
Postoperative (4%):
(i) trocar site hernia ( )
(ii) urinary retention ( )
Cadrobbi et al., 1999 [58]12Laparoscopic drainageNA92%8%:
bleeding from the peritoneal window ( )
Ostrowski et al., 2000 [59]9Laparoscopic drainageNA89%None
Melvin et al., 1997 [60]8Laparoscopic drainageNA75% (only 6 follow-up)None
Gill et al., 1995 [61]38Open drainage ( ) versus
laparoscopic drainage ( )
NA73% versus 100%Open drainage (12%):
(i) prolonged ileus ( )
(ii) transection of the ureter of a transplant kidney ( )
(iii) pneumonitis ( )
Laparoscopic drainage (8%):
cystotomy requiring open repair ( )

Minimal invasive therapy
Kim et al., 1999 [30]23Percutaneous catheter drainageNA96%* to 100%**17%:
(i) secondary infection ( )
(ii) skin infection ( )
(iii) catheter dislodgement ( )
Kurata et al., 2003 [31]10Percutaneous catheter drainageNA90%None
Conte et al., 1990 [32]8Percutaneous catheter drainageNA88% to 100%**None
White et al., 1985 [29]11Simple aspiration ( ) and
percutaneous catheter drainage ( )
NA82%27%
lymphocele infection ( )
Jensen et al., 1986 [33]8Simple aspiration ( ) and
percutaneous catheter drainage ( )
NA75% (only 7 follow-up)None
Akhan et al., 2007 [34]60Percutaneous catheter drainage ( ) and
sclerotherapy ( )
Ethanol70% and 98%*12%
(i) catheter dislodgement ( )
(ii) secondary infection ( )
Akhan et al., 2000 [35]38Percutaneous catheter drainage ( ) and
sclerotherapy ( )
Ethanol97% to 100%**Not mentioned/unknown
Zuckerman and Yeager, 1997 [36]32SclerotherapyEthanol94%9%:
secondary infection ( )
Sawhney et al., 1996 [37]14SclerotherapyEthanol93% to 100%**None
Akhan et al., 1992 [38]8SclerotherapyEthanol88% to 100%**None
Kuzuhara et al., 1994 [39]4SclerotherapyEthanol75%Not mentioned/unknown
Alago et al., 2013 [40]70Percutaneous catheter drainage ( ) versus
sclerotherapy ( )
Povidone-iodine74% to 97%** versus 100%*34%
(i) pericatheter fluid leakage ( )
(ii) catheter dislodgement ( )
(iii) catheter occlusion ( )
(iv) secondary infection of the collection ( )
Rivera et al., 1996 [41]19SclerotherapyPovidone-iodine62.5% to 100%**15%:
secondary infection ( )
Montalvo et al., 1996 [42]17SclerotherapyPovidone-iodine82% to 100%**Not mentioned/unknown
Cohan et al., 1988 [43]13Percutaneous catheter drainage ( ) and
sclerotherapy ( )
Povidone-iodine83%* 
86%
None
Gilliland et al., 1989 [44]9Sclerotherapy ( )Povidone-iodine89%None
Shokeir et al., 1993 [45]30Percutaneous catheter drainage ( ) and
sclerotherapy ( )
Tetracycline93%Not mentioned/unknown
Caliendo et al., 2001 [46]21SclerotherapyDoxycycline95%*27%:
minor discomfort or
transient mild temperature elevation ( )
Folk and Musa, 1995 [47]3SclerotherapyDoxycycline67%None
VanSonnenberg et al., 1986 [48]14Percutaneous catheter drainage ( ) and
sclerotherapy ( )
Tetracycline
povidone-iodine
79% Not mentioned/unknown
Mahrer et al., 2010 [4]43SclerotherapyPovidone-iodine
ethanol
doxycycline
77%*35%:
(i) cellulitis ( )
(ii) severe testicular pain ( )
(iii) ureteral obstruction and increased creatinine level ( )
(iv) acute tubular necrosis ( )
(v) localized peritonitis ( )
Chin et al., 2003 [49]8SclerotherapyFibrin glue75%*38%:
(i) clogging of drainage catheters ( )
(ii) catheter dislodgement ( )
Kerlan et al., 1997 [50]4SclerotherapyBleomycin100%*25%
transient episode of fever ( )

Several modalities
Atray et al., 2004 [62]36Simple aspiration ( ),
percutaneous catheter drainage ( ),
sclerotherapy ( ),
open drainage ( ), and
laparoscopic drainage ( )
Ethanol 100%
67%
75%
88%
88%
Sclerotherapy:
infection ( )
Open drainage
infection ( )
Ziȩtek et al., 2007 [63]14Percutaneous catheter drainage ( ) followed by
laparoscopic drainage ( )
50%
86%
None

: number of lymphoceles. NA: not applied. *After multiple sessions. **Considering asymptomatic recurrence.