Modified enteromesenteric bridging operation for primary lymphedema

Abstract

BACKGROUND: Primary lymphedema represents a condition which affects the lymph vessels and their cells without any
pathologic patient history leading to soft tissue swelling. They are described in the literature three types: congenital primary lymphedema, or Milroy disease, lymphedema praecox, which occurs in puberty, and lymphedema tarda, when, the
same symptoms, develop over 35 years old patients. The aim of this paper is to present a modified Kimmoth’s original
procedure for a praecox lymphedema by introducing an omental flap in the resorptive area.
CASE REPORT: We present a case of 18 year-old patient with a significant lymphedema of the lower limbs and genitalia associated with high-symptomatic under-knee and scrotal ulcerative, necrotic and inflammatory lesions. The ultrasound and computed-tomography scans showed bilateral hypertrophic lymph-nodes in the inguinal and external iliac areas.
Considering this diagnosis we decided to perform a physiologic lymph drainage by combining the enteromesenteric bridge
with the omental transposition. The postoperative course was favorable without wound complications. Three months after,
it was resected the remnant scrotal sclero-lymphatic tissue. 3 years after surgery, the clinical follow-up showed a significant reduced lymphedema with 10 cm shank / 15 cm thigh circumference lost.
CONCLUSIONS:The enteromesenteric bridge combined with the omental flap proved to be efficient in ensuring the lymphatic drainage in a case with proximal lymphatic occlusion.