ISSN: 2577-297X
Authors: Hakeem N , Almuashi I , Alghamdi A , Almonaye H , Elsayed A and Alassiri I
Postoperative pelvic collections of lymphatic origin are uncommon complications following acetabular fracture fixation. We report a 71-year-old man who developed a large anterior extraperitoneal pelvic collection after open reduction and internal fixation of a right both-column acetabular fracture using the modified Stoppa approach. Comprehensive biochemical analysis and lymphoscintigraphy confirmed a lymphatic origin as the underlying cause of the pelvic collection and excluded alternative etiologies including urinoma, chylous leak, pancreatic leak, bile leak, infection, and malignancy. Persistent high-output drainage ranging between 200-600 mL per/day continued despite two sessions of intranodal lymphangiography with glue embolization. Chemical sclerotherapy using tigecycline diluted in normal saline was subsequently attempted but did not reduce drainage output. The patient later developed secondary infection, which was successfully treated with targeted antibiotic therapy. With prolonged controlled drainage and multidisciplinary management, the lymphatic fistula eventually resolved during outpatient follow-up. At one-year follow-up, radiographs demonstrated complete fracture union, and the patient returned to his preinjury functional status without recurrence. This case highlights a rare complication of the modified Stoppa approach and demonstrates that delayed spontaneous resolution may occur even after failure of interventional therapies.
Clinical Message: Persistent postoperative pelvic collections should prompt evaluation for lymphatic injury. Even when interventional treatments fail, prolonged controlled drainage may result in spontaneous resolution, avoiding unnecessary repeated procedures.
Keywords: Refractory pelvic collection; Acetabular fracture; Modified Stoppa approach; Lymphatic complication; Lymphocele; Lymphatic Leak; Case report
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