Posttransplant lymphocele presenting as 'acute abdomen'.

Lymphoceles occurring after renal transplantation are frequently asymptomatic and are usually identified on routine ultrasonography of the allograft. A small percentage of them may increase in size and manifest due to their compression effects on adjacent structures or as lymphocutaneous fistula. An infected lymphocele would, in addition, give rise to local and systemic features. A case of infected lymphocele occurring 4.5 months after cadaveric renal transplant is reported. The patient presented in septicemia and features of generalized peritonitis. Emergency diagnostic laparoscopy revealed fluid collection in the peritoneal cavity. However, on exploratory laparotomy no intra-abdominal pathology was detected. Further evaluation revealed a large perigraft lymph collection which was drained percutaneously. Fluid and blood cultures grew Staphylococcus aureus. The patient recovered completely following external drainage and antibiotic administration.