title: Late aortic lymphocele and residual ovary syndrome after gynecological surgery.
abstract: BACKGROUND
  Gynecological surgery, as radical hysterectomy or pelvic and aortic lymphadenectomy, accounts for more than 50% of iatrogenic injuries. In premenopausal women, an hysterectomy with ovarian sparing and concomitant lateral ovarian transposition is frequently performed. However, the fate of the retained ovary is complicated by the residual ovarian syndrome (ROS) and one of the most common postoperative complications of the lymphadenectomy procedure is the lymphocele, with an average incidence of 22-48.5%. The differential diagnosis of a postoperative fluid collection includes, in addition to a lymphocele, urinoma, hematoma, seroma or abscess and the computed tomography (CT) findings alone is not enough.
  
  
  METHODS
  We describe a patient, affected by ROS concomitant with a asymptomatic lymphocele, initially confused with an aortic lymph nodes relapse, after abdominal radical hysterectomy. The patient was subjected to a surgical approach, included a diagnostic open laparoscopy and laparotomy with sovraombelico-pubic incision, wide opening of the pelvic peritoneum and retroperitoneum. Examination of the mass revealed, macroscopically, a ovary with multiloculated cystic masses filled with clear or yellow serous fluid and the layers were composed by flat or cuboidal mesothelial cells.
  
  
  CONCLUSIONS
  The tribute of this case illustrates the atypical appearance with uncertain aetiology after complex imaging. Gynecologist and radiologist should acquaint with the appearance of fluid collection (urinoma, lymphocele, seroma, hematoma, abscess) in gynecologic oncology follow-up to properly differentiated from tumor recurrence.
authors.affiliation: Dept of Obstetrics and Gynecology, "La Sapienza" University, Rome, Italy. natalina.manci@uniroma1.it.
authors.forename: Maria
authors.initials: M
authors.lastname: Pastore
authors.forename: Natalina
authors.initials: N
authors.lastname: Manci
authors.forename: Claudia
authors.initials: C
authors.lastname: Marchetti
authors.forename: Francesca
authors.initials: F
authors.lastname: Esposito
authors.forename: Marialetizia
authors.initials: M
authors.lastname: Iuliano
authors.forename: Lucia
authors.initials: L
authors.lastname: Manganaro
authors.forename: Pierluigi Benedetti
authors.initials: PB
authors.lastname: Panici