Prevention of lymphatic vessel rupture

  When human filariasis causes inflammation of the lymphatic vessels and thickens the walls, the lymphatic vessels from the intestinal trunk to the thoracic duct are dilated, the valves in the vessels close incompletely and produce a dynamic obstruction, causing a blockage of lymphatic fluid and an increase in pressure in the lymphatic vessels, which can rupture at the weakest point. The common site of rupture is at the fornix of the renal pelvis, and a pelvic-lymphatic fistula may result.  Prevention: 1) Non-surgical treatment includes bed rest and lowering the pressure in the lymphatic vessels to promote early healing of the pelvis and calyx-lymphatic fistula. Also use anti-inflammatory drugs or herbal medicines that clear heat and detoxify the blood to stop bleeding. Avoiding fatty diets can often achieve better results in patients with early disease and mild symptoms.  2) Renal pelvic irrigation: 1% silver nitrate is used for renal pelvic irrigation to make the lymphatic fistula coagulate and heal, but the recurrence rate is high.  3) Renal lymphatic stripping: The renal artery and the upper part of the pelvic ureter are each stripped about 2 cm high, so that all the lymphatic vessels entering and leaving the kidney are ligated, which keeps the lymphatic fluid in the high-pressure lymphatic vessels from flowing back into the kidney, which can lead to pelvic and calyx-lymphatic fistulas. After decompression, the fistula can heal. In bilateral celiac disease, the procedure is usually performed in two stages, but most of them resolve on the severe side without the need for surgery on the opposite side. This procedure is suitable for patients with severe recurrent symptoms, but the recurrence rate is between 8.4% and 14%.  4) Lymphovascular vein anastomosis surgery: including lumbar stem lymphovascular and spermatic (ovarian) vein anastomosis, thoracic duct odd vein anastomosis, inguinal spermatic lymph and vein anastomosis, and lower limb lymphovascular vein anastomosis, etc. Although there are some reports in the past, but the efficacy is uncertain and the recurrence rate is high, so it is rarely used at present.