A Case of Refractory Lymphocele Following Living Donor Kidney Transplantation Treated With Percutaneous Balloon Fenestration Into the Peritoneal Cavity Using Interventional Radiology.

Introduction: Post-kidney transplantation lymphocele is a common complication, usually managed with percutaneous drainage, lymphangiography, or surgical fenestration. We report a refractory case successfully treated with percutaneous balloon fenestration into the peritoneal cavity using interventional radiology. Case Presentation: A woman in her 60s with end-stage renal disease from diabetic nephropathy underwent living-donor kidney transplantation. Two weeks later, a lymphocele developed with a predominant subcutaneous component and a smaller peritransplant retroperitoneal collection, requiring repeated percutaneous aspiration. At 2 months, lymphangiography did not demonstrate an active leak. At 3 months, CT-guided puncture and dilation were used to create a passage between the lymphocele and the peritoneal cavity, with placement of a 10-Fr catheter. The catheter was removed after 3 weeks, and no recurrence has been observed for 2.5 years. Conclusion: Interventional radiology-based percutaneous balloon fenestration into the peritoneal cavity may be an effective alternative to surgical fenestration in refractory post-transplant lymphocele.