Lymphatic Leakage in Pediatric Heart Transplantation: Early Recognition and Timely Management with Interventional Radiologic and Endoscopic Therapy

Carolena Trocchia, Tian Mauer, Sally Mitchell, Michael Collard, Alfred Asante-Korang, Michael Wilsey
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Abstract

Protein-losing enteropathy (PLE) is a severe complication of the Fontan procedure that leads to systemic complications owing to enteric protein loss. Hepatoduodenal lymphatic leakage resulting from increased lymphatic pressure is one such complication. We present the case of a pediatric heart transplant patient who experienced refractory PLE symptoms requiring serial albumin infusions and exhibited lymphatic leakage into the duodenum. Using diagnostic lymphangiography and endoscopy, we identified the affected area and treated it successfully with endoscopic sclerotherapy using ethanolamine injection. This treatment allowed for the cessation of lymphatic fluid and may serve as a potential intervention for PLE-associated hepatoduodenal lymphatic leakage. The present case highlights the importance of early recognition and timely intervention with radiology and endoscopic therapy to manage PLE and its associated complications.
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小儿心脏移植淋巴渗漏:介入放射和内镜治疗的早期识别和及时处理
蛋白质丢失性肠病(PLE)是Fontan手术的一种严重并发症,由于肠道蛋白质丢失导致全身性并发症。肝十二指肠淋巴渗漏是由淋巴压力增加引起的一种并发症。我们报告一例小儿心脏移植患者,他经历了难治性PLE症状,需要连续白蛋白输注,并表现出淋巴渗漏到十二指肠。通过诊断性淋巴管造影和内窥镜检查,我们确定了受影响的区域,并成功地使用乙醇胺注射进行内窥镜硬化治疗。这种治疗允许淋巴液的停止,并可能作为一种潜在的干预与ple相关的肝十二指肠淋巴渗漏。本病例强调了早期识别和及时干预放射学和内镜治疗的重要性,以管理PLE及其相关并发症。
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