Laparoscopic management in a rare case of bilateral perirenal lymphangiomatosis
A 23-year-old female presented with complaints of bilateral loin pain, more on the right side, for the past 3 months. The pain was dull aching, continuous and non-radiating. On examination, her vitals were stable. Per-abdominal examination showed a vague non-tender mass palpable in the right lumbar region. Her routine urine and blood investigations were found to be within normal limits. Ultrasonogram (USG) showed bilateral perirenal collection with septations and the collection was seen to extend into the renal sinuses []. The kidneys were normal and the corticomedullary differentiations were maintained on both sides. Computed tomography (CT) scan of abdomen showed bilateral perirenal hypodense multiloculated collection, with density varying between 8 and 12 HU []. Delayed films showed normal excretion of the contrast with splaying of the pelvi-calyceal system with intervening fluid in the sinuses. No extravasation of the contrast was noted into the collection. Magnetic resonance imaging (MRI) showed a perirenal hyperintense collection in T2W images and also in the renal sinus []. A diagnosis of perirenal lymphangiectasis was made. She underwent laparoscopic deroofing and marsupialization of the perirenal collection on either side [Figure and ]. She had an uneventful recovery but for a persistent drain which subsided by the 12th day postoperatively. The deroofed specimen showed thin-walled multiple cysts which on histological examination were found to be lined by thin endothelial cells. The patient made a complete recovery and is on regular follow-up for the past 18 months [].