Bilateral renal lymphangiectasia in a postpartum woman managed with renal decapsulation: a case report with follow-up after a subsequent pregnancy

Background Renal lymphangiectasia is a rare benign disorder involving the dilatation of renal lymphatic channels. While often incidental, it can cause significant morbidity through renal compression. We report a unique case of symptomatic bilateral disease presenting in the immediate postpartum period, managed with a novel surgical approach. Case presentation A 23-year-old female presented five days postpartum with progressive left flank pain, nausea, and a blood pressure of 140/90 mmHg. Computed tomography (CT) demonstrated large bilateral perinephric fluid collections causing substantial compression of the kidneys and adjacent organs, along with moderate ascites. Fluid analysis from a perinephric drain was consistent with lymph. Interventions Due to severe compressive effects and early recurrence following percutaneous drainage, the patient underwent laparoscopic surgical intervention. The procedure involved the complete excision of the markedly thickened renal capsule (decapsulation) and the creation of a posterior peritoneal drainage window to facilitate continuous fluid absorption. Conclusion At 16 months post-operation, imaging confirmed significant radiological regression and preserved renal function. Notably, follow-up extended after a subsequent pregnancy showed no recurrence of fluid collections, and the patient remained asymptomatic. Complete renal decapsulation with a peritoneal window provided definitive treatment in this severe bilateral case.