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Chronic edema is caused by lymphatic impairment due to either overload of interstitial fluid or anatomic/functional lymphatic failure in any part of the body. Lymphatics play a crucial role in interstitial homeostasis, immune surveillance and fat absorption in the gut. Lymphedema is a clinical sign with swelling and not a diagnosis. In the latter stages inflammatory processes lead to fat formation and fibrosis. Untreated lymphedema has an increased risk for erysipelas, physical dysfunction and tends to worsen. Obesity and reduced physical activity are the main influenceable risk factors after oncological treatments in patients with impaired lymphatics. Prior to a multidisciplinary treatment program, a proper diagnosis with health profile is made. Treatment exists of two phases: an initial treatment phase and a maintenance phase in which the focus is on compression, self-management, exercise, minimizing risk factors and creating a healthy lifestyle. Clinimetrics are important for monitoring in both phases.

Three patients are described who developed irreversible lymphedema of the arm following mastectomy because of breast cancer. Despite maximal conservative treatment, a difference in volume between the affected arm and the healthy arm remained (900-1500 ml). The patients underwent reductive surgery by means of circumferential suction assisted lipectomy, involving removal of hypertrophied adipose tissue. This was the first experience with this procedure in the Netherlands. The differences in arm volume were neutralised completely with a significant improvement of the shoulder function. In order to make the results lasting, the patients have to wear medical elastic stockings day and night for the rest of their lives. Long-term volume measurements are essential.

A 6-year-old boy developed macroscopic haematuria on the 4th day after appendectomy for acute appendicitis, at which the appendix was found to be perforated. During the next few days the urine secretion decreased and malaise, pain in the lower abdomen, nausea and vomiting occurred. On a management of ample fluid administration, the urine secretion recovered and the symptoms subsided in a few days. In the early postoperative stage after appendectomy in children the possibility should be kept in mind of the development of acute renal insufficiency due to bilateral ureteral obstruction as a result of oedema of the posterior bladder wall, even if by means of ultrasonography only mild to moderate abnormalities are noted. Awaiting decompression by means of the introduction of bilateral ureteric stents, in order to prevent irreversible renal damage, supportive therapy with fluid administration depending on the diuresis seems indicated.