Lymphedema and Chylous Complications

Lymphedema Surgery in Hyderabad, India

It occurs when lymph fluid collects in the soft tissues, most commonly in the arms and legs. In normal circumstances, the nodes of the lymphatic system filter lymph fluid, which is rich in protein. Lymph fluid accumulates and causes swelling when nodes are obstructed, which severely limits their filtering capacity.

CARE Hospitals Department of Urology offers comprehensive evaluation, diagnosis, and treatment to patients suffering from chylous, whether they are adults or children.

Our goal is to be the best urology hospital in the world by providing advanced diagnostic, treatment, prevention, and services for a wide range of urological and kidney disorders.

How does lymphedema affect my body?

Lymphedema can cause swelling in various parts of the body, including the arms, legs, and feet, leading to discomfort and difficulty in performing daily tasks. Individuals with lymphedema often experience physical pain and may feel self-conscious due to changes in their appearance caused by the condition.

Stages of lymphedema

The stages of lymphedema are typically classified as follows:

• Stage 0: The affected region may experience sensations of swelling, tightness, and heaviness, although there are no visible signs of swelling externally.
• Stage I: Occasional swelling may occur, which typically resolves when the affected area is elevated.
• Stage II: Persistent swelling is evident in the affected area, with the skin feeling firmer compared to adjacent areas.
• Stage III: Significant swelling is present, accompanied by observable changes in skin color and texture in the affected area.

Symptoms

Swelling, Heaviness, Tightness & Itching: The affected limb or body part may experience swelling and heaviness, as well as tightness and itching.

Progressive Swelling

• There may be a gradual swelling of the affected limb that significantly reduces mobility.
• Skin Problems: Infections, Hardening & Thickening
• As lymphedema progresses, it can lead to recurrent skin infections, irreversible soft tissue swelling, and, ultimately, hardening and thickening of the skin.

Causes

Primary lymphedema occurs when lymph nodes and/or blood vessels do not develop properly. It is predominantly a female condition. Symptoms often appear after birth, although the deficiency may already exist at birth. The most common site for primary lymphedema is in the legs, but it can affect any part of the body.

Lymphedema secondary to radiation treatment, lymph node removal, blood vessel damage or destruction as a consequence of radiation treatment, or lymphatic filariasis (elephantiasis) is the most common reason for secondary lymphedema. Additionally, it can be caused by a chronic overload of the lymphatic system caused by recurrent skin infections, problems with the blood vessels, or obesity. In secondary lymphedema, the lymph nodes are absent or injured in the body part with the swelling.

Diagnosis

In cases where swelling occurs without pain after removing lymph nodes or when damaged lymph nodes are removed, this may indicate lymphedema. A physical examination of the affected limb or body part is sometimes sufficient to confirm the diagnosis.

Tests May Be Needed 

Treatment options can sometimes be identified through lymphoscintigraphy, an imaging technique of the lymphatic system.

Treatment

Taking the appropriate lymphedema treatment can prevent future complications such as infections of lymph vessels (lymphangitis), bacterial infections of the skin (cellulitis), and a form of soft tissue cancer called lymphangiosarcoma.

In order to treat the symptoms of lymphedema, compression therapy is proven to be a reliable and effective method. By pressing on the lower legs and feet, compression socks/stockings promote healthy blood circulation. During the high-pressure session, swollen feet are reduced, lymph is stimulated, and scarring and itching of the skin are also prevented.

The following are some easy ways to reduce your risk of lymphedema:

• Keep your body weight at a healthy level.

• Do not wear tight clothes.

• Protect your arms and legs from injuries.

• Hydrate your skin every day to prevent infections.

• After cancer treatment, make sure you exercise regularly to build strength and flexibility.

• Make sure you wear graduated compression stockings.

• Lymphedema is complicated when ignored in the early stages.

Complications

Lymphedema that occurs repeatedly or untreated may result in other complications. Some of these include:

With lymphedema, it is common to suffer from repeated episodes of cellulitis. Cellulitis is caused by bacteria in the deep layers of the skin and in the soft tissues beneath the skin.

Lymphangitis is an inflammation of the lymph vessels caused by a bacterial infection caused by Streptococcus. Bacteria in the bloodstream can cause bacteraemia if it spreads into the skin and adjacent soft tissues. If left untreated, it can also cause cellulitis.

For those who have lived with cancer, lymphedema can affect their appearance, which can have a psychological effect. It may even lead to higher rates of depression. 

What are Chylous Ascites?

The chyle consists of lymph and small fat droplets. It carries fats and proteins, helps the body fight germs, and maintains the body's fluid level.

Chyle is transported to the bloodstream by lymph vessels. The blood then carries lymph and fats to their destinations.

In the case of damaged or non-functioning lymphatics, this normal flow cannot occur. Chyle is unable to enter the bloodstream and leaks into other locations instead. Ascites from chylous ascites leak into the belly.

Signs & Symptoms of Chylous Ascites

In spite of the little fluid in the belly, chylous ascites may not cause any symptoms. The fluid can build up and cause:

• a large, rounded belly

• a swelling or bulge at the belly button (umbilical hernia)

• loss of appetite

• one or more lumps in the groin (from a hernia or swollen lymph nodes)

• swelling of the genitals or legs

• trouble breathing

• vomiting

Causes Chylous Ascites

The condition usually affects children because:

• The child is born with a problem in the lymphatic system.

• Trauma that damages lymph vessels

Chylous Ascites Diagnosis

Prenatal ultrasounds showing fluid in a baby's belly may suggest chylous ascites before the child is born. More tests will be conducted to confirm this diagnosis.

In children and infants, doctors will test the fluid in the belly. Samples are collected by a needle, and then sent to the lab for analysis. X-rays, ultrasounds, CT scans, or MRIs may be done to determine how the fluid has entered the belly and if the fluid has chyle.

Laparoscopic surgery can be used if doctors need more information. In order to diagnose problems, they make small cuts in the belly and use a tiny camera and instruments.

Chylous Ascites Treatment

Doctors will closely monitor the mother's pregnancy if a foetus has chylous ascites. When she gives birth, the baby will be taken care of in the NICU.

The treatment depends on what's causing the condition. A cystic ascites caused by a leak in the lymphatic system may heal on its own.

If necessary, treatment may include:

• A needle is used to remove fluid from the belly.

• Drains are placed under the belly to let the fluid drain out.

• A low-fat diet, medicine, or IV nutrition (total parenteral nutrition, or TPN) may reduce the body's production of chyle.

• An interventional radiologist can fix the lymph vessel.