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1
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Kamata M, Aoki Y, Ikki A, Murakami A, Kanao H. Long-term conservative treatment of chylous ascites in gynecological malignant surgery: a case report and literature review. Int Cancer Conf J 2025; 14:79-84. [PMID: 40160870 PMCID: PMC11950597 DOI: 10.1007/s13691-024-00738-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 11/24/2024] [Indexed: 04/02/2025] Open
Abstract
Chylous ascites is a rare complication of abdominal surgery. Although most patients show improvement with conservative treatment. Long-term leakage of chylous ascites can cause malnutrition, dehydration, and immunosuppression; therefore, an early cure is desirable, but no standard treatment for chylous ascites has been established, and determining the timing of surgical intervention is difficult. A 74-year-old woman underwent surgery for carcinosarcoma of the fallopian tube, including dissection of the pelvic and para-aortic lymph nodes. She was noted to have a large amount of chylous ascites postoperatively. Furthermore, a low-fat diet, weekly ascites punctures and lymphangiography were performed. However, the leakage was not resolved. After ten weeks of intensive treatment with fasting, total parenteral nutrition (TPN), octreotide, etilefrine, and fibrogammin, beginning 18 weeks postoperatively, the chylous ascites changed to serous and disappeared. Long-term conservative treatment may improve chylous ascites, and continued conservative treatment without surgical intervention is an option. The patient was resistant to a low-fat diet, although fasting and TPN were effective. In addition, a change in the color of the ascites from milky white to serous as a precursor to improvement of the erosive ascites may help to consider the timing of surgical intervention.
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Affiliation(s)
- Mayumi Kamata
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550 Japan
| | - Yoichi Aoki
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550 Japan
| | - Ai Ikki
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550 Japan
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo, Japan
| | - Atsushi Murakami
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550 Japan
- Department of Obstetrics and Gynecology, Kohka Public Hospital, 1256 Matsuo, Minaguchi, Koka, Shiga, Japan
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550 Japan
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2
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Ashida H, Kisaki S, Enoki K, Ojiri H. Interventional Radiology in Management of Postoperative Chylous Ascites. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2025; 10:e20230039. [PMID: 40384916 PMCID: PMC12078024 DOI: 10.22575/interventionalradiology.2023-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/08/2024] [Indexed: 05/20/2025]
Abstract
Postoperative chylous ascites is a rare condition that can be caused by abdominal and pelvic surgery. The mortality rate associated with untreated postoperative lymphorrhea is as high as 50%. Conservative management is the primary treatment, and most patients improve. However, some patients continue to exhibit high-volume chylous ascites and need invasive intervention. Many surgical series have shown that the outcomes of patients with chylous ascites were unfavorable. Therefore, the need for minimally invasive interventional radiology procedures, such as intranodal lymphangiography, thoracic duct, lymphatic pseudoaneurysm, lymph node, hepatic lymphatic embolization, and peritoneovenous shunting, is increasing. This review describes the anatomy, physics, and diagnosis related to interventional radiology for postoperative chylous ascites as well as interventional radiology treatment options and strategies for this condition referring to recent literature.
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Affiliation(s)
- Hirokazu Ashida
- Department of Radiology, The Jikei University School of Medicine, Japan
| | - Shunsuke Kisaki
- Department of Radiology, The Jikei University School of Medicine, Japan
| | - Keitaro Enoki
- Department of Radiology, The Jikei University School of Medicine, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, Japan
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3
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Kamiya N, Noro T, Okazaki T, Ishitsuka N, Suzuki Y, Iijima S, Sugizaki Y, Somoto T, Oka R, Utsumi T, Endo T, Kasuya S, Hiruta N, Suzuki H. Multidisciplinary Treatment for Lymphorrhea and Chylorrhea Following Lymph Node Dissection for Genitourinary Cancer. Cancers (Basel) 2025; 17:592. [PMID: 40002187 PMCID: PMC11853674 DOI: 10.3390/cancers17040592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Revised: 01/31/2025] [Accepted: 02/08/2025] [Indexed: 02/27/2025] Open
Abstract
BACKGROUND Lymph node dissection (LND) is often performed in genitourinary cancer to improve accurate staging. However, the resultant lymphatic damage often leads to postoperative lymphorrhea and chylorrhea. Further, since lymphatic fluid lacks platelets, it has very few clotting factors, and it is often difficult to treat postoperative lymphatic leakage. Treatments for lymphorrhea include conservative treatment (e.g., fasting, total parenteral nutrition, and drug therapy), interventional radiology (IR) and surgical treatment. However, there is no guideline of refractory lymphorrhea, and no clear criteria for switching to the next treatment. METHODS We reviewed the records of 28 patients at Toho University Sakura Medical Center with postoperative lymphorrhea or chylorrhea after LND that did not improve with conservative treatment. Based on this analysis, we partially revised the treatment algorithm for lymphorrhea developed by Rose et al. Results: The cases consisted of 26 men and two women, aged 65.0 ± 9.9 years. The mean number of lymph nodes removed was 25.3 ± 15.0. Octreotide was administered in 27 patients, lymphangiography was performed in three patients, and lymphatic embolization was performed in two patients. The mean duration of octreotide administration was 9.7 ± 6.1 days, and the mean dose was 211.1 µg/day. The treatment success rates with octreotide and IR were 78.6% and 100%, respectively. The mean duration of drain placement after surgery for primary cancer was 18.3 ± 14.3 days. CONCLUSIONS Patients with lymphorrhea and chylorrhea should be initially treated conservatively, with IR performed if conservative treatment is unsuccessful. Surgical treatment should be a last resort.
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Affiliation(s)
- Naoto Kamiya
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi 285-8741, Chiba, Japan; (T.N.); (T.O.); (N.I.); (Y.S.); (S.I.); (Y.S.); (T.S.); (R.O.); (T.U.); (T.E.); (H.S.)
| | - Takahide Noro
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi 285-8741, Chiba, Japan; (T.N.); (T.O.); (N.I.); (Y.S.); (S.I.); (Y.S.); (T.S.); (R.O.); (T.U.); (T.E.); (H.S.)
| | - Taro Okazaki
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi 285-8741, Chiba, Japan; (T.N.); (T.O.); (N.I.); (Y.S.); (S.I.); (Y.S.); (T.S.); (R.O.); (T.U.); (T.E.); (H.S.)
| | - Naoki Ishitsuka
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi 285-8741, Chiba, Japan; (T.N.); (T.O.); (N.I.); (Y.S.); (S.I.); (Y.S.); (T.S.); (R.O.); (T.U.); (T.E.); (H.S.)
| | - Yuta Suzuki
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi 285-8741, Chiba, Japan; (T.N.); (T.O.); (N.I.); (Y.S.); (S.I.); (Y.S.); (T.S.); (R.O.); (T.U.); (T.E.); (H.S.)
| | - Shota Iijima
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi 285-8741, Chiba, Japan; (T.N.); (T.O.); (N.I.); (Y.S.); (S.I.); (Y.S.); (T.S.); (R.O.); (T.U.); (T.E.); (H.S.)
| | - Yuka Sugizaki
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi 285-8741, Chiba, Japan; (T.N.); (T.O.); (N.I.); (Y.S.); (S.I.); (Y.S.); (T.S.); (R.O.); (T.U.); (T.E.); (H.S.)
| | - Takatoshi Somoto
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi 285-8741, Chiba, Japan; (T.N.); (T.O.); (N.I.); (Y.S.); (S.I.); (Y.S.); (T.S.); (R.O.); (T.U.); (T.E.); (H.S.)
| | - Ryo Oka
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi 285-8741, Chiba, Japan; (T.N.); (T.O.); (N.I.); (Y.S.); (S.I.); (Y.S.); (T.S.); (R.O.); (T.U.); (T.E.); (H.S.)
| | - Takanobu Utsumi
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi 285-8741, Chiba, Japan; (T.N.); (T.O.); (N.I.); (Y.S.); (S.I.); (Y.S.); (T.S.); (R.O.); (T.U.); (T.E.); (H.S.)
| | - Takumi Endo
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi 285-8741, Chiba, Japan; (T.N.); (T.O.); (N.I.); (Y.S.); (S.I.); (Y.S.); (T.S.); (R.O.); (T.U.); (T.E.); (H.S.)
| | - Shusuke Kasuya
- Department of Radiology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi 285-8741, Chiba, Japan;
| | - Nobuyuki Hiruta
- Department of Surgical Pathology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi 285-8741, Chiba, Japan;
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi 285-8741, Chiba, Japan; (T.N.); (T.O.); (N.I.); (Y.S.); (S.I.); (Y.S.); (T.S.); (R.O.); (T.U.); (T.E.); (H.S.)
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Yazici SE, Turan E, Atasever A. A rare type of ascites in liver cirrhosis: Chylous ascites. Asian J Surg 2024; 48:S1015-9584(24)02346-7. [PMID: 39505649 DOI: 10.1016/j.asjsur.2024.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 10/07/2024] [Indexed: 11/08/2024] Open
Affiliation(s)
- Sinan Efe Yazici
- Demiroglu Bilim University, Faculty of Medicine, Department of General Surgery, Florence Nightingale Hospital Liver Transplantation Center, Istanbul, Turkey.
| | - Ebru Turan
- Demiroglu Bilim University, Faculty of Medicine, Istanbul, Turkey.
| | - Ahmet Atasever
- Demiroglu Bilim University, Faculty of Medicine, Department of General Surgery, Florence Nightingale Hospital Liver Transplantation Center, Istanbul, Turkey.
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5
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Nicaise EH, Morton E, Croll B, Palmateer G, Patel G, Swilley B, Master VA. Multidisciplinary management of chylous ascites following resection of a retroperitoneal, functional Paraganglioma. Urol Case Rep 2024; 57:102888. [PMID: 39664937 PMCID: PMC11632745 DOI: 10.1016/j.eucr.2024.102888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 11/05/2024] [Accepted: 11/13/2024] [Indexed: 12/13/2024] Open
Abstract
Extra-adrenal, functional paraganglioma, if not medically controlled, requires early surgical resection. This can often be challenging when found in a retroperitoneal location, where resections are prone to lymphatic disruption and chyle leaks. Chylous ascites carry a significant risk of protein and caloric malnutrition, dehydration, and even mortality given the nutrient-rich characteristic of lost lymphatic fluid. Dietary modification involving minimal fat intake is often frontline conservative treatment, however, prolonged, heavy-volume chylous ascites will require advanced medical and surgical intervention. This case illustrates the difficulties, complexities, and solutions with multidisciplinary management of lymphatic leakage following resection of a functional, retroperitoneal paraganglioma.
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Affiliation(s)
- Edouard H. Nicaise
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Ernest Morton
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Benjamin Croll
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Gregory Palmateer
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Gaurav Patel
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Bryan Swilley
- Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
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6
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Gómez FM, Baetens TR, Santos E, Rocha BL, Horwitz B, Lojo-Lendoiro S, Vargas P, Patel P, Beets-Tan R, Martínez-Rodrigo JJ, Bonmatí LM. Interventional solutions for post-surgical problems: a lymphatic leaks review. CVIR Endovasc 2024; 7:61. [PMID: 39126551 PMCID: PMC11316727 DOI: 10.1186/s42155-024-00473-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
The lymphatic circulation plays a crucial role in maintaining fluid balance and supporting immune responses by returning serum proteins and lipids to the systemic circulation. Lymphatic leaks, though rare, pose significant challenges post-radical neck surgery, oesophagectomy, and thoracic or retroperitoneal oncological resections, leading to heightened morbidity and mortality. Managing lymphatic leaks necessitates consideration of aetiology, severity, and volume of leakage. Traditionally, treatment involved conservative measures such as dietary restrictions, drainage, and medical management, with surgical intervention reserved for severe cases, albeit with variable outcomes and extended recovery periods. Lymphography, introduced in the 1950s, initially served as a diagnostic tool for lymphoedema, lymphoma, tumour staging, and monitoring chemotherapy response. However, its widespread adoption was impeded by alternative techniques like Computed Tomography, learning curves, and its associated complications. Contemporary lymphatic interventions have evolved, favouring nodal lymphangiography over pedal lymphangiography for its technical simplicity and reduced complexity. Effective management of chylous leaks mandates a multimodal approach encompassing clinical evaluation and imaging techniques. In cases where conservative management proves ineffective, embolization through conventional lymphangiography by bipedal dissection or intranodal injection emerges as a viable option. This review underscores the importance of a comprehensive approach to diagnosing and treating lymphatic leaks, highlighting advancements in imaging and therapeutic interventions that enhance patient outcomes.
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Affiliation(s)
- Fernando M Gómez
- Biomedical Imaging Research Group (GIBI2^30), La Fe Health Research Institute (IIS La Fe), Avenida Fernando Abril Martorell, València, 46026, Spain.
- Radiology Department, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell, València, 46026, Spain.
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands.
| | - Tarik R Baetens
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
| | - Ernestos Santos
- Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Boris León Rocha
- Department of Interventional Radiology, Hospital Clínico de la Universidad de Chile, Santos Dumont 999, Independencia, Región Metropolitana, Chile
| | - Benjamín Horwitz
- Radiology Department, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, 7650568, Chile
| | - Sara Lojo-Lendoiro
- Department of Radiology, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, 36312, Spain
| | - Patricio Vargas
- Radiology Department, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, 7650568, Chile
| | - Premal Patel
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Regina Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
| | - José J Martínez-Rodrigo
- Biomedical Imaging Research Group (GIBI2^30), La Fe Health Research Institute (IIS La Fe), Avenida Fernando Abril Martorell, València, 46026, Spain
| | - Luis Martí Bonmatí
- Biomedical Imaging Research Group (GIBI2^30), La Fe Health Research Institute (IIS La Fe), Avenida Fernando Abril Martorell, València, 46026, Spain
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Bazuhair AA, AlSubeai HS, AlKhardawi SH, AlKhlaiwy OY, Alkhums KA. Understanding acute chyloperitoneum in appendicitis: case report and literature review. J Surg Case Rep 2024; 2024:rjae527. [PMID: 39220170 PMCID: PMC11364456 DOI: 10.1093/jscr/rjae527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
Chyloperitoneum is the presence of chyle in the peritoneal cavity. This study focuses on acute chyloperitoneum, a rare condition with an unclear incidence due to limited number of reported cases in the literature. Here, we present a 24-year-old Saudi female with chyloperitoneum diagnosed intraoperatively during a laparoscopic appendectomy for acute appendicitis that was managed successfully with a low-fat diet and drainage, alongside a literature review to elucidate the condition's pathophysiology and therapeutic strategies. A conservative management approach is recommended for acute chyloperitoneum in the context of appendicitis, this includes intraperitoneal drainage, appendectomy when needed, and careful observation. Our proposed management strategy aligns with findings from the literature review and supports conservative management as a safe and effective treatment modality for this rare condition.
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Affiliation(s)
- Abdulaziz A Bazuhair
- Department of General Surgery, Security Forces Hospital, King Fahad Suburb, Dammam 31413, Kingdom of Saudi Arabia
| | - Hessa S AlSubeai
- Department of General Surgery, Security Forces Hospital, King Fahad Suburb, Dammam 31413, Kingdom of Saudi Arabia
| | - Sarah H AlKhardawi
- Department of General Surgery, Security Forces Hospital, King Fahad Suburb, Dammam 31413, Kingdom of Saudi Arabia
| | - Omar Y AlKhlaiwy
- Department of General Surgery, Security Forces Hospital, King Fahad Suburb, Dammam 31413, Kingdom of Saudi Arabia
| | - Khaldoon A Alkhums
- Department of General Surgery, Security Forces Hospital, King Fahad Suburb, Dammam 31413, Kingdom of Saudi Arabia
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8
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Badawy A, Mourad M, Sharan MA, Elyamany AS, Elgendi A, Said H, Bahaa M, Abdelghafar MF. Chylous Ascites: A Rare Complication After Donor Right Hepatectomy. INDIAN JOURNAL OF TRANSPLANTATION 2024; 18:330-332. [DOI: 10.4103/ijot.ijot_32_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/04/2024] [Indexed: 01/03/2025] Open
Abstract
Abstract
Chylous ascites (CA) is a rare complication after abdominal surgeries, particularly donor hepatectomy and liver transplantation. We present a case of CA developed following donor right hepatectomy. Initially managed with a high-protein, low-fat diet and Sandostatin® (Octreotide Acetate), the patient’s condition improved but did not resolve. Subsequently, the treatment plan was modified to include clear oral fluids, total parenteral nutrition, and Sandostatin®, resulting in a significant improvement and ultimate discontinuation of CA drainage. This case sheds light on the management strategies for CA following donor hepatectomy and emphasizes the need for a multimodal approach.
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Affiliation(s)
- Amr Badawy
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Mourad
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Abdallah Sharan
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amany Saleh Elyamany
- Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Elgendi
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hany Said
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Bahaa
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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9
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Tan X, Luo G, Liao G, Liao H. Postoperative Chylous Ascites in Gynecological Malignancies: Two Case Reports and a Literature Review. Obstet Gynecol Int 2024; 2024:1810634. [PMID: 38957414 PMCID: PMC11219204 DOI: 10.1155/2024/1810634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/04/2023] [Accepted: 06/14/2024] [Indexed: 07/04/2024] Open
Abstract
Aim To explore the potential factors that influence the presentation and recovery of postoperative chylous ascites (CA) in gynecological malignancies. Methods We reported two cases of postoperative CA following gynecological surgery and reviewed the clinical features of 140 patients from 16 relevant papers. Patients' clinicopathological characteristics, surgical approach, and management were summarized. The onset and resolution times of postoperative CA in different groups were analyzed separately. Results The two patients in our report had recovery after conservative treatments. According to the literature review, the median time of onset of postoperative CA was 5 days (range, 0-75 days) after surgery. The median resolution time was 9 days (range, 2-90 days). Among patients, 87.14% of them had lymphadenectomy during gynecological surgeries, while 92.86% of the patients had resolution after conservative treatments. Conclusions Lymphadenectomy during surgery may be relevant to the postoperative CA. Conservative management could be the initial choice for postoperative CA treatment.
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Affiliation(s)
- Xin Tan
- Obstetrics and Gynecology DepartmentWest China Second University HospitalSichuan University, Chengdu 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenSichuan UniversityMinistry of Education, Chengdu 610041, Sichuan, China
| | - GuoLin Luo
- Obstetrics and Gynecology DepartmentWest China Second University HospitalSichuan University, Chengdu 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenSichuan UniversityMinistry of Education, Chengdu 610041, Sichuan, China
| | - Guangdong Liao
- Obstetrics and Gynecology DepartmentWest China Second University HospitalSichuan University, Chengdu 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenSichuan UniversityMinistry of Education, Chengdu 610041, Sichuan, China
| | - Hong Liao
- Obstetrics and Gynecology DepartmentWest China Second University HospitalSichuan University, Chengdu 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenSichuan UniversityMinistry of Education, Chengdu 610041, Sichuan, China
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10
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Sinicropi T, Mazzeo C, Sofia C, Biondo SA, Cucinotta E, Fleres F. Acute Chyloperitoneum with Small Bowel Volvulus: Case Series and Systematic Review of the Literature. J Clin Med 2024; 13:2816. [PMID: 38792360 PMCID: PMC11122546 DOI: 10.3390/jcm13102816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/02/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024] Open
Abstract
Introduction: Chyloperitoneum arises from lymph leakage into the abdominal cavity, leading to an accumulation of milky fluid rich in triglycerides. Diagnosis can be challenging, and mortality rates vary depending on the underlying cause, with intestinal volvulus being just one potential acute cause. Despite its rarity, our case series highlights chyloperitoneum associated with non-ischemic small bowel volvulus. The aims of our study include assessing the incidence of this association and evaluating diagnostic and therapeutic approaches. Material and Methods: We present two cases of acute abdominal peritonitis with suspected small bowel volvulus identified via contrast-enhanced computed tomography (CT). Emergency laparotomy revealed milky-free fluid and bowel volvulus. Additionally, we conducted a systematic review up to 31 October 2023, identifying 15 previously reported cases of small bowel volvulus and chyloperitoneum in adults (via the PRISMA scheme). Conclusions: Clarifying the etiopathogenetic mechanism of chyloperitoneum requires specific diagnostic tools. Magnetic resonance imaging (MRI) may be useful in non-emergency situations, while contrast-enhanced CT is employed in emergencies. Although small bowel volvulus infrequently causes chyloperitoneum, prompt treatment is necessary. The volvulus determines lymphatic flow obstruction at the base of the mesentery, with exudation and chyle accumulation in the abdominal cavity. Derotation of the volvulus alone may resolve chyloperitoneum without intestinal ischemia.
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Affiliation(s)
- Teresa Sinicropi
- Section of General Surgery, Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (T.S.); (C.M.); (S.A.B.); (E.C.)
| | - Carmelo Mazzeo
- Section of General Surgery, Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (T.S.); (C.M.); (S.A.B.); (E.C.)
| | - Carmelo Sofia
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino” Via Consolare Valeria 1, 98125 Messina, Italy;
| | - Santino Antonio Biondo
- Section of General Surgery, Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (T.S.); (C.M.); (S.A.B.); (E.C.)
| | - Eugenio Cucinotta
- Section of General Surgery, Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (T.S.); (C.M.); (S.A.B.); (E.C.)
| | - Francesco Fleres
- Section of General Surgery, Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (T.S.); (C.M.); (S.A.B.); (E.C.)
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11
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Matsumura M, Mise Y, Takemura N, Ono Y, Sato T, Ito H, Inoue Y, Takahashi Y, Saiura A. An Elemental Diet Reduces Chylous Ascites of Patients Undergoing Pancreatoduodenectomy in the Setting of Early Enteral Feeding. Pancreas 2024; 53:e343-e349. [PMID: 38354366 DOI: 10.1097/mpa.0000000000002309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
OBJECTIVES The elemental diet (ED) is a formula to support nutritional status without increasing chylous burden. This study evaluates the efficacy of early ED feeding after pancreatoduodenectomy (PD). MATERIALS AND METHODS A prospective phase II study of consecutive patients who underwent PD with early ED feeding was conducted. Patient backgrounds, surgical outcomes, and ED feeding tolerability were compared with a historical cohort of 74 PD patients with early enteral feeding of a low residue diet (LRD). RESULTS The ED group comprised 104 patients. No patient in the ED group discontinued enteral feeding because of chylous ascites (CAs), whereas 17.6% of the LRD group experienced refractory CAs that disrupted further enteral feeding. The CAs rate was significantly decreased in the ED group compared with the LRD group (3.9% and 48.7%, respectively; P < 0.001). There was no significant difference in the incidence of major complications (ED: 17.3%, LRD: 18.9%; P = 0.844). Postoperative prognostic nutritional index was similar between the 2 groups ( P = 0.764). In multivariate analysis, enteral feeding formula, and sex were independent risk factors for CAs (LRD: P < 0.001, odds ratio, 22.87; female: P = 0.019, odds ratio, 2.78). CONCLUSIONS An ED reduces postoperative CAs of patients undergoing PD in the setting of early enteral feeding.
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Affiliation(s)
- Masaru Matsumura
- From the Department of Hepatobiliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake Hospital, 3-8-31 Ariake, Koto-ku
| | - Yoshihiro Mise
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Nobuyuki Takemura
- From the Department of Hepatobiliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake Hospital, 3-8-31 Ariake, Koto-ku
| | - Yoshihiro Ono
- From the Department of Hepatobiliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake Hospital, 3-8-31 Ariake, Koto-ku
| | - Takafumi Sato
- From the Department of Hepatobiliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake Hospital, 3-8-31 Ariake, Koto-ku
| | - Hiromichi Ito
- From the Department of Hepatobiliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake Hospital, 3-8-31 Ariake, Koto-ku
| | - Yosuke Inoue
- From the Department of Hepatobiliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake Hospital, 3-8-31 Ariake, Koto-ku
| | - Yu Takahashi
- From the Department of Hepatobiliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake Hospital, 3-8-31 Ariake, Koto-ku
| | - Akio Saiura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
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12
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Alzaghran R, AlGhamdi FS, Alshubaily F, Alhothaifi E. Chyle and Bile Leak Following Open Cholecystectomy: A Rare Complication. Cureus 2024; 16:e59338. [PMID: 38817462 PMCID: PMC11137640 DOI: 10.7759/cureus.59338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Gallstone disease is extremely common and frequently and safely treated by cholecystectomy. Chyle leak is a rare but significant side effect of many abdominal surgeries with rarely reported post-cholecystectomy. In this case, we report a 78-year-old lady with multiple comorbidities and symptomatic gallstones who underwent open cholecystectomy complicated by bile and chyle leak, which was successfully managed with endoscopic retrograde cholangiopancreatography (ERCP) and stenting for bile leak and conservative management for the chyle leak, which included drainage, low-fat diet, and octreotide.
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Affiliation(s)
| | - Faisal S AlGhamdi
- General Surgery Department, Prince Sultan Military Medical City, Riyadh, SAU
| | | | - Essam Alhothaifi
- Hepato-Pancreato-Biliary Surgery, General Surgery Department, King Saud Medical City, Riyadh, SAU
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13
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Ellison C, Igarashi Y, Kevorkian N. Chylous drainage through percutaneous cholecystostomy: an extremely rare complication. J Surg Case Rep 2024; 2024:rjae094. [PMID: 38426184 PMCID: PMC10902259 DOI: 10.1093/jscr/rjae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/04/2024] [Indexed: 03/02/2024] Open
Abstract
Chyle leak is a rare but potentially morbid complication of abdominal surgery. There have been seven reported cases of chylous ascites following cholecystectomy, but no such occurrences are reported with percutaneous cholecystostomy tube (PCT) insertion. We report the case of a 67-year-old female with stage IVb recurrent uterine papillary serous carcinoma and extensive abdominal surgical history including a paraesophageal hernia repair, and a robotic hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, gastrocolic omentectomy, and hepatoduodenal lymphadenectomy. The patient presented with clinical findings suggestive of acute cholecystitis and decision was made to proceed with PCT placement. The PCT was dislodged and replaced during her course and several days after chylous output was noted from the PCT. The remainder of her hospital course was complicated by persistent distributive shock, adrenal insufficiency, and continued chyle leak. She ultimately was transitioned to inpatient hospice and died shortly after.
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Affiliation(s)
- Christina Ellison
- General Surgery Residency Program, University of Connecticut, Farmington, CT 06032, USA
| | - Yuichi Igarashi
- University of Connecticut School of Medicine, Farmington, CT 06032, USA
| | - Noubar Kevorkian
- Department of Surgery, The Hospital of Central Connecticut, New Britain, CT 06052, USA
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14
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Woo SJ, Hur S, Kim HS, Chang H, Kim JY, Park SJ, Jin US. Hybrid Lymphovenous Anastomosis Surgery Guided by Intraoperative Mesenteric Intranodal Lymphangiography for Refractory Nontraumatic Chylous Ascites: A Case Report. Arch Plast Surg 2024; 51:130-134. [PMID: 38425866 PMCID: PMC10901586 DOI: 10.1055/s-0043-1776304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/03/2023] [Indexed: 03/02/2024] Open
Abstract
Refractory chylous ascites can cause significant nutritional and immunologic morbidity, but no clear treatment has been established. This article introduces a case of a 22-year-old female patient with an underlying lymphatic anomaly who presented with refractory chylous ascites after laparoscopic adnexectomy for ovarian teratoma which aggravated after thoracic duct embolization. Ascites (>3,000 mL/d) had to be drained via a percutaneous catheter to relieve abdominal distention and consequent dyspnea, leading to significant cachexia and weight loss. Two sessions of hybrid lymphovenous anastomosis (LVA) surgery with intraoperative mesenteric lymphangiography guidance were performed to decompress the lymphatics. The first LVA was done between inferior mesenteric vein and left para-aortic enlarged lymphatics in a side-to-side manner. The daily drainage of chylous ascites significantly decreased to 130 mL/day immediately following surgery but increased 6 days later. An additional LVA was performed between right ovarian vein and enlarged lymphatics in aortocaval area in side-to-side and end-to-side manner. The chylous ascites resolved subsequently without any complications, and the patient was discharged after 2 weeks. The patient regained weight without ascites recurrence after 22 months of follow-up. This case shares a successful experience of treating refractory chylous ascites with lymphatic anomaly through LVA, reversing the patient's life-threatening weight loss. LVA was applied with a multidisciplinary approach using intraoperative mesenteric lipiodol, and results showed the possibility of expanding its use to challenging problems in the intraperitoneal cavity.
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Affiliation(s)
- Soo Jin Woo
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Saebeom Hur
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hak Chang
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji-Young Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soo Jin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ung Sik Jin
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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15
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Philip D, Garcia M, Anika M, Avila A, Seaver C. Laparoscopic cholecystectomy: post-operative bile and chyle leaks. A case report. J Surg Case Rep 2023; 2023:rjad532. [PMID: 37771881 PMCID: PMC10532111 DOI: 10.1093/jscr/rjad532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
One week after an elective laparoscopic cholecystectomy at an outside hospital, a 56-year-old male presented to the emergency department with right-sided abdominal pain. Computerized tomography (CT) revealed a complex fluid collection in the gallbladder fossa. The patient underwent drain placement and received broad-spectrum intravenous antibiotics. Drain output was suspicious for a chyle leak, which was confirmed by elevated fluid triglyceride levels. Magnetic resonance cholangiopancreatography (MRCP) and hepatobiliary iminodiacetic acid (HIDA) analysis showed evidence of a concurrent bile leak. After starting a low fat, high protein diet and octreotide, a common bile duct sphincterotomy with plastic stent placement was performed. The patient's symptoms and drain output proceeded to improve. The cause of the chyle leak is unclear. However, with consideration of the patient's concurrent bile leak, an injury to the right major lymphatic drainage pathway and adjacent bile duct is suspected.
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Affiliation(s)
- Dwight Philip
- Herbert Wertheim College of Medicine, Florida International University, Miami 33199, United States
| | - Maxine Garcia
- Adult General Surgery, Memorial Hospital West, Pembroke Pines 33028, United States
| | - Maisha Anika
- Herbert Wertheim College of Medicine, Florida International University, Miami 33199, United States
| | - Azalia Avila
- Adult General Surgery, Memorial Hospital West, Pembroke Pines 33028, United States
| | - Christopher Seaver
- Adult General Surgery, Memorial Hospital West, Pembroke Pines 33028, United States
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16
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Pieper CC. Back to the Future II-A Comprehensive Update on the Rapidly Evolving Field of Lymphatic Imaging and Interventions. Invest Radiol 2023; 58:610-640. [PMID: 37058335 DOI: 10.1097/rli.0000000000000966] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
ABSTRACT Lymphatic imaging and interventional therapies of disorders affecting the lymphatic vascular system have evolved rapidly in recent years. Although x-ray lymphangiography had been all but replaced by the advent of cross-sectional imaging and the scientific focus shifted to lymph node imaging (eg, for detection of metastatic disease), interest in lymph vessel imaging was rekindled by the introduction of lymphatic interventional treatments in the late 1990s. Although x-ray lymphangiography is still the mainstay imaging technique to guide interventional procedures, several other, often less invasive, techniques have been developed more recently to evaluate the lymphatic vascular system and associated pathologies. Especially the introduction of magnetic resonance, and even more recently computed tomography, lymphangiography with water-soluble iodinated contrast agent has furthered our understanding of complex pathophysiological backgrounds of lymphatic diseases. This has led to an improvement of treatment approaches, especially of nontraumatic disorders caused by lymphatic flow abnormalities including plastic bronchitis, protein-losing enteropathy, and nontraumatic chylolymphatic leakages. The therapeutic armamentarium has also constantly grown and diversified in recent years with the introduction of more complex catheter-based and interstitial embolization techniques, lymph vessel stenting, lymphovenous anastomoses, as well as (targeted) medical treatment options. The aim of this article is to review the relevant spectrum of lymphatic disorders with currently available radiological imaging and interventional techniques, as well as the application of these methods in specific, individual clinical situations.
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Affiliation(s)
- Claus C Pieper
- From the Division for Minimally Invasive Lymphatic Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn; and Center for Rare Congenital Lymphatic Diseases, Center of Rare Diseases Bonn, Bonn, Germany
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17
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Nepali A, Guragain A, Devkota K, Paudyal P, Prasad Rimal S, Kafle A, Jung Karki R, Kumari S, Shrestha R. Chylous ascites following retroperitoneal lymphadenectomy in a patient with recurrent dysgerminoma of ovary: A case report. Gynecol Oncol Rep 2023; 48:101221. [PMID: 37576351 PMCID: PMC10422095 DOI: 10.1016/j.gore.2023.101221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/26/2023] [Accepted: 06/04/2023] [Indexed: 08/15/2023] Open
Abstract
Chylous ascites is an uncommon condition of accumulation of milky fluid rich in lymph and chylomicrons in the peritoneal cavity. Post-surgical complications following dissection near the base of the mesentery, retroperitoneum, or near the cisterna chyli, malignancies (e.g., pancreatic adenocarcinomas, lymphoma, gastric carcinoma), cirrhosis, and trauma are the prime causes of chylous ascites. Here we report a rare case of chylous ascites following clearance of isolated paraaortic nodal recurrence in a 28-year-old female with dysgerminoma of ovary. The patient developed chylous ascites on the fifth day following surgery, which was confirmed by an increased drain fluid triglyceride level. She was managed conservatively with dietary modification including a high-protein and carbohydrate but low-fat-based diet mainly containing medium-chain fatty acids. Subsequently, she recovered from chylous ascites on the sixteenth day, completed second line chemotherapy, and is now doing well.
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Affiliation(s)
- Amit Nepali
- B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Karun Devkota
- Department of Radiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Punam Paudyal
- Department of Pathology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Surya Prasad Rimal
- Department of Obstetrics and Gynaecology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Awaj Kafle
- Department of Urosurgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Rikesh Jung Karki
- Department of Urosurgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Shilpi Kumari
- Department of Nutrition, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Ramesh Shrestha
- Department of Obstetrics and Gynaecology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
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18
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Dahill KE, Falconer J, Pozniak A, Bracchi M. Mycobacterial disease causing chylous effusions in two patients living with uncontrolled HIV. BMJ Case Rep 2023; 16:e252000. [PMID: 37495372 PMCID: PMC10373729 DOI: 10.1136/bcr-2022-252000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Chylous effusions are a rare complication of disseminated non-tuberculous mycobacterial (NTM) infection. This is a case couplet reporting on the treatment challenge of chylous effusions secondary to NTM infection in two individuals living with advanced HIV. Their treatment was complicated by associated immune reconstitution inflammatory syndrome. They both required intermittent paracentesis, steroid treatment and transitioning on to fat-free diets alongside NTM treatment. Only after months of this treatment regimen was successful resolution of the associated chylous effusions achieved. Chylous effusions in immunosuppressed patients living with NTM infection are rarely reported and difficult to manage. This report discusses treatment approaches and highlights the difficulties faced by the treating team.
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Affiliation(s)
- Katherine Elizabeth Dahill
- Critical care, University Hospital Aintree, Liverpool, UK
- HIV department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jonathan Falconer
- HIV department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Anton Pozniak
- HIV department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Margherita Bracchi
- HIV department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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19
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Wang K, Xiao J, Li L, Li X, Yang Y, Liu Z, Jiang J. The application of a medium-chain fatty diet and enteral nutrition in post-operative chylous leakage: analysis of 63 patients. Front Nutr 2023; 10:1128864. [PMID: 37545584 PMCID: PMC10399236 DOI: 10.3389/fnut.2023.1128864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background Post-operative chylous leakage (CL) is the pathologic leakage of chylomicron fluid after surgery. This retrospective study was performed to evaluate a uniform oral nutrition management strategy on the post-operative CL. Methods We retrospectively reviewed patients who developed post-operative CL and received consultation from a clinical nutritionist in seven departments of the Second Affiliated Hospital of Dalian Medical University from May 2020 to April 2022. We designed the oral nutrition intervention program which mainly standardized the type and amount of foods contained in the medium-chain triglyceride (MCT) diet. The influencing factors of curative efficacy were analyzed. Finally, binary logistic regression analysis was conducted to observe the relationship between curative efficacy and potentially predictive variables, including post-operative albumin, post-operative hemoglobin, surgical procedure, and drainage volume at consultation. Results Sixty-three patients with post-operative CL were included in this analysis. Of this number, 58 patients were cured successfully without other treatments. Three patients had a significantly prolonged recovery period, and the remaining two cases were treated by reoperation therapy. The leakage volume at the initiation of enteral intervention had no statistically significant difference in seven surgical departments and surgical sites (left, right, median, and bilateral). The length of stay (LOS) of patients with CL after the intervention was not significantly increased in cardiac, hepatobiliary, gastrointestinal, and urological surgeries. Patients with CL had longer LOS than those without CL in gynecology (P=0.044) and thyroid surgery departments (P=0.008). Each unit increase in post-operative hemoglobin would increase the probability of an effective outcome by 8%, which was statistically significant (P = 0.037). Conclusion In treating patients with post-operative CL, we recommend the MCT diet and EN as the first option, rather than fasting, parenteral nutrition (PN), or octreotide.
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Affiliation(s)
- Ke Wang
- Department of Clinical Nutrition, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jiaming Xiao
- Department of Nutrition and Food Hygiene, School of Public Health, Dalian Medical University, Dalian, Liaoning, China
| | - Li Li
- Department of Clinical Nutrition, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xu Li
- Department of Clinical Nutrition, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yilun Yang
- Department of Clinical Nutrition, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Zhiyu Liu
- Department of Urological Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jing Jiang
- Department of Nursing, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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20
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Jafari A, Reihani H, Karbasian F, Darban B, Dehghani SM. Chylous ascites as a rare complication of abdominal trauma in a 7-year-old girl: A case report. Clin Case Rep 2023; 11:e7408. [PMID: 37405045 PMCID: PMC10315450 DOI: 10.1002/ccr3.7408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/06/2022] [Accepted: 05/02/2023] [Indexed: 07/06/2023] Open
Abstract
Key Clinical Message Abdominal trauma can be one of the causes of chylous ascites in pediatric cases, along with tuberculosis and malignancy. However, a definitive diagnosis is more reasonable to be done by excluding other causes. Abstract Chylous ascites (CA) is a rare type of ascites. Though it has high mortality and morbidity rates, which usually happen due to the rupture of lymph vessels into the peritoneal cavity. Congenital abnormalities, including lymphatic hypoplasia or dysplasia, are the most causes in pediatrics. CA following trauma in children is very rare, and to the best of our knowledge, there are very few reports in this regard. Here, we report a 7-year-old girl who was referred to our center with CA after a car accident.
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Affiliation(s)
- Anahita Jafari
- Gastroenterology and Hepatology Research CenterShiraz University of Medical SciencesShirazIran
| | - Hamid Reihani
- School of MedicineShiraz University of Medical SciencesShirazIran
| | - Fereshteh Karbasian
- Department of Pediatric Gastroenterology and HepatologyIran University of Medical SciencesTehranIran
| | - Behnaz Darban
- Department of Pediatric Gastroenterology and HepatologyIran University of Medical SciencesTehranIran
- Department of Pediatric GastroenterologyHormozgan University of Medical SciencesBandar AbbasIran
| | - Seyed Mohsen Dehghani
- Gastroenterology and Hepatology Research CenterShiraz University of Medical SciencesShirazIran
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21
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Zaman M, Ryncarz R, Chen A, Yildirim S, Iskhagi S, Saidi R, Bratslavsky G, Shahbazov R. Chylous Ascites After Robot-Assisted Laparoscopic Donor Nephrectomy: Is Early Surgical Intervention Necessary? EXP CLIN TRANSPLANT 2023; 21:397-407. [PMID: 37334687 DOI: 10.6002/ect.2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
OBJECTIVES Chylous ascites is a rare complication that may occur after living donor nephrectomy. The continuous loss of lymphatics, which carries a high risk of morbidity, may ensue in possible immunodeficiency and protein-calorie malnutrition. Here, we presented patients who developed chylous ascites after robotassisted living donor nephrectomy and reviewed the current literature of therapeutic strategies for chylous ascites. MATERIALS AND METHODS We reviewed the medical records of 424 laparoscopic living donor nephrectomies performed at a single transplant center; among these, we studied the records of 3 patients who developed chylous ascites following robot-assisted living donor nephrectomy. RESULTS Among 438 living donor nephrectomies, 359 (81.9%) were laparoscopic and 77 (18.1%) were by robotic assistance. In the 3 cases highlighted in our study, patient 1 did not respond to conservative therapy, which consisted of diet optimization, total parenteral nutrition, and octreotide (somatostatin). Patient 1 subsequently underwent robotic-assisted laparoscopy with suture ligation and clipping of leaking lymphatic vessels, allowing the chylous ascites to subside. Patient 2 similarly did not respond to conservative treatment and developed ascites. Despite initial improvement after wound interrogation and drainage, patient 2 had continued symptoms, resulting in diagnostic laparoscopy and repair of leaky channels leading to the cisterna chyli. Patient 3 developed chylous ascites 4 weeks postoperatively and received ultrasonographic-guided paracentesis by interventional radiology, with results showing an aspirate consistent with chyle. The patient's diet was optimized, allowing for initial improvement and eventual return to normal diet. CONCLUSIONS Our case series and literature review demonstrate the importance of early surgical intervention after failed conservative management for resolution of chylous ascites in patients after robotassisted donor laparoscopic nephrectomy.
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Affiliation(s)
- Muizz Zaman
- From the Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York; the Choate Rosemary Hall, Wallingford, Connecticut
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22
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Sakai L, Aguilera P, Karmegam S. Acute Chylous Ascites Status Post Median Arcuate Ligament Syndrome Decompression: A Unique Case Report and Literature Review. Cureus 2023; 15:e35300. [PMID: 36968858 PMCID: PMC10037925 DOI: 10.7759/cureus.35300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/21/2023] [Indexed: 02/24/2023] Open
Abstract
Chylous ascites (CA) are a rare finding of triglyceride-rich peritoneal fluid within the abdominal cavity. Malignancy, cirrhosis, and trauma after abdominal surgery are the leading causes of CA in adults. Currently, there are no published guidelines on the management of CA. This report describes a case of an 18-year-old female presenting with abdominal pain and distention following median arcuate ligament syndrome (MALS) decompression. A computed tomography (CT) of the abdomen and pelvis showed large-volume ascites with normal hepatic morphology. Paracentesis and ascitic fluid studies were positive for milky fluid rich in triglyceride. Her recent history of MALS decompression revealed the cause of her acute CA to be a postoperative complication from her abdominal surgery. This case highlights the diverse etiology of ascites and the importance of a careful history and physical examination when evaluating adults with ascites.
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23
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Chylous Ascites: Reassessment of Diagnostic Criteria in Patients With Portal Hypertension. Am J Gastroenterol 2023; 118:364-366. [PMID: 36379155 DOI: 10.14309/ajg.0000000000002072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The triglyceride (TG) threshold for diagnosis of chylous ascites in patients with portal hypertension remains uncertain. METHODS Retrospective analysis of lipoprotein electrophoresis was conducted in 286 consecutive ascites samples. RESULTS Ascitic TG ≥ 81 mg/dL is 95.4% sensitive and 94.6% specific for chylous ascites diagnosed by the presence of significant chylomicron population. DISCUSSION The cutoff for chylous ascites diagnosis should be TG ≥ 81 mg/dL.
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24
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Muacevic A, Adler JR, Zia BF, Ashraf A, Khawar A. Chylous Ascites Pointing Toward an Internal Hernia in the Setting of Roux-en-Y Gastric Bypass: A Case Report. Cureus 2023; 15:e33857. [PMID: 36819359 PMCID: PMC9934932 DOI: 10.7759/cureus.33857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2023] [Indexed: 01/19/2023] Open
Abstract
Chylous ascites is a rare but significant complication of a variety of surgical procedures. It is an uncommon complication of laparoscopic Roux-en-Y gastric bypass (LRGYB). The underlying etiology is assumed to be an internal hernia, in which the hernia causes lymphatic channel engorgement and lymphatic extravasation. We present the case of a 34-year-old male who had a history of LRGYB a year back and had been experiencing gradually worsening, colicky abdominal pain radiating to the right flank for the last 24 hours. Laparoscopic exploration revealed chylous ascites due to internal herniation owing to the complication of LRYGB. Classic signs of internal hernias such as mesenteric swirl were absent on the computed tomography scan of the abdomen.
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Muacevic A, Adler JR, Singh G, Farooq A, Hurairah A. Milky Ascites: A Diagnostic Dilemma. Cureus 2023; 15:e34008. [PMID: 36811040 PMCID: PMC9939078 DOI: 10.7759/cureus.34008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 01/21/2023] Open
Abstract
Chylous ascites is a milky-appearing, triglyceride-rich fluid within the abdominal cavity. It is a rare finding that arises from the disruption of the lymphatic system and can be caused by a wide variety of pathologies. Here, we present a diagnostically challenging case of chylous ascites. In this article, we discuss the pathophysiology and various etiologies of chylous ascites, explore the diagnostic tools available, and highlight the management strategies implemented in this rare finding.
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Intranodal Ultrasound-Guided Percutaneous Methylene Blue Injection for the Identification of Leakage Point during Laparoscopic Repair of Refractory Chylous Ascites after Laparoscopic Lymphadenectomy for Kidney Cancer. Case Rep Urol 2022; 2022:3817554. [DOI: 10.1155/2022/3817554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/09/2022] [Accepted: 11/01/2022] [Indexed: 11/22/2022] Open
Abstract
Chylous ascites is an uncommon complication after surgery that can result in malnutrition and immunodeficiency. Therefore, surgical interventions are reserved for refractory patients, and the primary success factor for these interventions is locating the point of leakage, which is often tricky. We describe a case of a 56-year-old male with chylous ascites after laparoscopic radical nephrectomy and lumbo-aortic lymphadenectomy for kidney cancer. The patient was initially managed with dietary modifications and drainage placement. Afterward, lymphography with Lipiodol, percutaneous embolization of the leakage point, and total parenteral nutrition were established. Finally, the patient underwent laparoscopic repair after identifying the leakage point by injecting methylene blue through an inguinal node. Complete resolution was achieved, and no complications related to the procedure were recorded. Intranodal methylene blue injection can be an invaluable tool to identify the point of leakage in selected patients to improve the outcomes of surgical repair of refractory chylous ascites.
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Kong PF, Xu YH, Lai ZH, Ma MZ, Duan YT, Sun B, Xu DZ. Novel management indications for conservative treatment of chylous ascites after gastric cancer surgery. World J Gastroenterol 2022; 28:6056-6067. [PMID: 36405388 PMCID: PMC9669821 DOI: 10.3748/wjg.v28.i42.6056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/15/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chylous ascites (CA) presents a challenge as a relatively common postoperative complication in gastric cancer (GC). Primary conservative therapy involved total parenteral nutrition, continuous low-pressure drainage, somatostatin, and a low-fat diet. Drainage tube (DT) clamping has been presented as a potential alternative conservative treatment for GC patients with CA. AIM To propose novel conservative treatment strategies for CA following GC surgery. METHODS The data of patients with CA after GC surgery performed at the Fudan University Shanghai Cancer Center between 2006 and 2021 were evaluated retrospectively. RESULTS 53 patients underwent surgery for GC and exhibited postoperative CA during the study period. Postoperative hospitalization and time of DT removal showed a significant positive association (R 2 = 0.979, P < 0.001). We further observed that delayed DT removal significantly extended the total and postoperative hospitalization, antibiotic usage duration, and hospitalization cost (postoperative hospitalization: 25.8 d vs 15.5 d, P < 0.001; total hospitalization: 33.2 d vs 24.7 d, P < 0.01; antibiotic usage duration: 10.8 d vs 6.2 d, P < 0.01; hospitalization cost: ¥9.2 × 104 vs ¥6.5 × 104, P < 0.01). Multivariate analysis demonstrated that postoperative infection and antibiotic usage were independent factors for delayed DT removal. Furthermore, DT removal times were shorter in seven patients who underwent DT clamping (clamped DT vs normal group, 11.8 d vs 13.6 d, P = 0.047; clamped DT vs delayed group, 13.6 d vs 27.4 d, P < 0.001). In addition, our results indicated that removal of the DT may be possible after three consecutive days of drainage volumes less than 300 mL in GC patients with CA. CONCLUSION Infection and antibiotic usage were vital independent factors that influenced delayed DT removal in patients with CA. Appropriate standards for DT removal can significantly reduce the duration of hospitalization. Furthermore, DT clamping might be a recommended option for conservative treatment of postoperative CA.
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Affiliation(s)
- Peng-Fei Kong
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Yong-Hu Xu
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Zhi-Hua Lai
- Department of the General Surgery, Suzhou Industrial Park Xinghai Hospital, Suzhou 215124, Jiangsu Province, China
| | - Ming-Zhe Ma
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Yan-Tao Duan
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Bo Sun
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Da-Zhi Xu
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
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Moazzam S, O'Hagan LA, Clarke AR, Itkin M, Phillips ARJ, Windsor JA, Mirjalili SA. The cisterna chyli: a systematic review of definition, prevalence, and anatomy. Am J Physiol Heart Circ Physiol 2022; 323:H1010-H1018. [PMID: 36206050 DOI: 10.1152/ajpheart.00375.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The cisterna chyli is a lymphatic structure found at the caudal end of the thoracic duct that receives lymph draining from the abdominal and pelvic viscera and lower limbs. In addition to being an important landmark in retroperitoneal surgery, it is the key gateway for interventional radiology procedures targeting the thoracic duct. A detailed understanding of its anatomy is required to facilitate more accurate intervention, but an exhaustive summary is lacking. A systematic review was conducted, and 49 published human studies met the inclusion criteria. Studies included both healthy volunteers and patients and were not restricted by language or date. The detectability of the cisterna chyli is highly variable, ranging from 1.7 to 98%, depending on the study method and criteria used. Its anatomy is variable in terms of location (vertebral level of T10 to L3), size (ranging 2-32 mm in maximum diameter and 13-80 mm in maximum length), morphology, and tributaries. The size of the cisterna chyli increases in some disease states, though its utility as a marker of disease is uncertain. The anatomy of the cisterna chyli is highly variable, and it appears to increase in size in some disease states. The lack of well-defined criteria for the structure and the wide variation in reported detection rates prevent accurate estimation of its natural prevalence in humans.
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Affiliation(s)
- Sara Moazzam
- School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Lomani A O'Hagan
- School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Alys R Clarke
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Maxim Itkin
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anthony R J Phillips
- Applied Surgery and Metabolism Laboratory, School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - John A Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - S Ali Mirjalili
- Department of Anatomy and Medical Imaging, The University of Auckland, Auckland, New Zealand
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Zurcher KS, Huynh KN, Khurana A, Majdalany BS, Toskich B, Kriegshauser JS, Patel IJ, Naidu SG, Oklu R, Alzubaidi SJ. Interventional Management of Acquired Lymphatic Disorders. Radiographics 2022; 42:1621-1637. [PMID: 36190865 DOI: 10.1148/rg.220032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The lymphatic system is a complex network of tissues, vessels, and channels found throughout the body that assists in fluid balance and immunologic function. When the lymphatic system is disrupted related to idiopathic, iatrogenic, or traumatic disorders, lymphatic leaks can result in substantial morbidity and/or mortality. The diagnosis and management of these leaks is challenging. Modern advances in lymphatic imaging and interventional techniques have made radiology critical in the multidisciplinary management of these disorders. The authors provide a review of conventional and clinically relevant variant lymphatic anatomy and recent advances in diagnostic techniques such as MR lymphangiography. A detailed summary of technical factors related to percutaneous lymphangiography and lymphatic intervention is presented, including transpedal and transnodal lymphangiography. Traditional transabdominal access and retrograde access to the central lymph nodes and thoracic duct embolization techniques are outlined. Newer techniques including transhepatic lymphangiography and thoracic duct stent placement are also detailed. For both diagnostic and interventional radiologists, an understanding of lymphatic anatomy and modern diagnostic and interventional techniques is vital to the appropriate treatment of patients with acquired lymphatic disorders. ©RSNA, 2022.
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Affiliation(s)
- Kenneth S Zurcher
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - Kenneth N Huynh
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - Aditya Khurana
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - Bill S Majdalany
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - Beau Toskich
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - J Scott Kriegshauser
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - Indravadan J Patel
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - Sailendra G Naidu
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - Rahmi Oklu
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - Sadeer J Alzubaidi
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
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Wabada S, Ibrahim HA, Dada BJ, Zanna AU, Muhammed A, Mustapha B. Management of chylous ascites with surgery and frusemide in a new born. Afr J Paediatr Surg 2022; 19:192-195. [PMID: 35775526 PMCID: PMC9290358 DOI: 10.4103/ajps.ajps_59_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chylous ascites is the accumulation of milky fat-rich chyle in the peritoneal cavity. It is a rare condition in children. Congenital malformations of the lymphatic vascular channel are the predominant cause in children. Diagnosis is often confirmed by paracentesis of the chylous ascitic fluid. Treatment is generally conservative except in rare refractory cases that surgery is required for closure of the leak site or excision of the lymphatic cyst. Here is a report on the management of chylous ascites in a 6-h-old girl presenting in acute respiratory distress with acute abdominal distention due rapid increase in chylous ascitic fluid volume that was managed with surgery and frusemide.
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Affiliation(s)
- Samuel Wabada
- Department of Surgery, Paediatric Surgery Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Halima Abubakar Ibrahim
- Department of Paediatrics, Neonatology Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Bisuma Joel Dada
- Department of Paediatrics, Neonatology Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Aisha Umaryyrah Zanna
- Department of Surgery, Paediatric Surgery Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Abdulmajeed Muhammed
- Department of Surgery, Paediatric Surgery Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Bello Mustapha
- Department of Paediatrics, Neonatology Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
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Risk factors of chylous ascites and its relationship with long-term prognosis in laparoscopic D3 lymphadenectomy for right colon cancer. Langenbecks Arch Surg 2022; 407:2453-2462. [PMID: 35589848 DOI: 10.1007/s00423-022-02527-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chylous ascites (CA) after laparoscopic D3 lymphadenectomy for right colon cancer is not rare. However, the risk factors for CA have not been fully explored. Few studies have investigated the effect of CA on long-term prognosis. METHODS The clinical data of patients with right colon cancer who underwent laparoscopic D3 lymphadenectomy in five centers from January 2013 to December 2018 were retrospectively collected. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with CA. Then, the long-term prognosis of patients with and without CA was compared by propensity score matching and Kaplan-Meier survival analysis. RESULTS The incidence of CA was 4.4% (48/1090). Pathological T stage (p = 0.025), dissection along the left side of the superior mesenteric artery (p < 0.001) and the number of retrieved lymph nodes (p < 0.001) were independent risk factors for CA. After propensity score matching, 48 patients in the CA group and 353 patients in the non-CA group were enrolled. Kaplan-Meier survival analysis indicated that CA was not associated with overall survival (p = 0.454) and disease-free survival (p = 0.163). In patients with stage III right colon cancer, there were no significant differences in overall survival (p = 0.501) and disease-free survival (p = 0.254). CONCLUSIONS Pathological T stage, number of retrieved lymph nodes, and left side dissection along the superior mesenteric artery were independent risk factors for CA after laparoscopic D3 lymphadenectomy. CA does not impair the oncological outcomes of patients.
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Ray M, Oberoi AS, Surya T, Saikia J. Management of Lymphatic Leaks After Retroperitoneal Lymph-Node Dissections in Gynecologic Cancers. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mukurdipi Ray
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India
| | - Ajit Singh Oberoi
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India
| | - Tshv Surya
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India
| | - Jyoutishman Saikia
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India
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Muzzolini M, Araujo RLC, Kingham TP, Peschaud F, Paye F, Lupinacci RM. Incidence and risk factors for Chyle leak after pancreatic surgery for cancer: A comprehensive systematic review. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:707-717. [PMID: 34887165 PMCID: PMC8995357 DOI: 10.1016/j.ejso.2021.11.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/25/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chyle leak (CL) is a clinically relevant complication after pancreatectomy. Its incidence and the associated risk factors are ill defined, and various treatments options have been described. There is no consensus, however, regarding optimal management. The present study aims to systematically review the literature on CL after pancreatectomy. METHODS A systematic review from PubMed, Scopus and Embase database was performed. Studies using a clear definition for CL and published from January 2000 to January 2021 were included. The PRISMA guidelines were followed during all stages of this systematic review. The MINORS score was used to assess methodological quality. RESULTS Literature search found 361 reports, 99 of which were duplicates. The titles and abstracts of 262 articles were finally screened. The references from the remaining 181 articles were manually assessed. After the exclusions, 43 articles were thoroughly assessed. A total of 23 articles were ultimately included for this review. The number of patients varied from 54 to 3532. Incidence of post pancreatectomy CL varied from 1.3% to 22.1%. Main risk factors were the extent of the surgery and early oral or enteral feeding. CL dried up spontaneously or after conservative management within 14 days in 53% to 100% of the cases. CONCLUSIONS The extent of surgery is the most common predictor of risk of CL. Conservative treatment has been shown to be effective in most cases and can be considered the treatment of choice. We propose a management algorithm based on the current available evidence.
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Affiliation(s)
- Milena Muzzolini
- AP-HP, Department of Digestive and Oncologic Surgery, Ambroise Paré Hospital, 9 Avenue Charles de Gaulle, 92104, Boulogne-Billancourt, France
| | - Raphael L C Araujo
- Department of Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Frédérique Peschaud
- AP-HP, Department of Digestive and Oncologic Surgery, Ambroise Paré Hospital, 9 Avenue Charles de Gaulle, 92104, Boulogne-Billancourt, France; Versailles St-Quentin-en-Yvelines/Paris Saclay University, UFR des Sciences de la Santé Simone Veil, 78180, Montigny-le-Bretonneux, France
| | - François Paye
- Department of Surgery, Saint Antoine Hospital, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France; Sorbonne Université, 75013, 91-105, Bd de l'Hôpital, Paris, France
| | - Renato M Lupinacci
- AP-HP, Department of Digestive and Oncologic Surgery, Ambroise Paré Hospital, 9 Avenue Charles de Gaulle, 92104, Boulogne-Billancourt, France; Versailles St-Quentin-en-Yvelines/Paris Saclay University, UFR des Sciences de la Santé Simone Veil, 78180, Montigny-le-Bretonneux, France.
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Strauss CE. Unexplained, congenital chyloperitoneum. BMJ Case Rep 2022; 15:e244372. [PMID: 35351769 PMCID: PMC8966495 DOI: 10.1136/bcr-2021-244372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/03/2022] Open
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35
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Gil González Y, Laseca-Modrego M, Arencibia-Sánchez O, González García-Cano D, Martin Martinez AI. Chylous Ascites Secondary to Retroperitoneal Para-Aortic Lymphadenectomy: A Case Report. Cureus 2022; 14:e22560. [PMID: 35345705 PMCID: PMC8957285 DOI: 10.7759/cureus.22560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/25/2022] Open
Abstract
Chylous ascites is caused by an accumulation of lymphatic fluid in the peritoneal cavity secondary to a rupture or obstruction of the abdominal lymphatic ducts. It has a milky appearance and is rich in triglycerides. The most frequent etiologies are neoplasms, liver cirrhosis, and ruptured lymphatic vessels after abdominal surgery. Clinically, it manifests as abdominal distention and increased abdominal girth. The presence of triglycerides in ascites fluid is the most useful diagnostic criterion. Treatment consists of a high-protein diet with fat restriction and medium-chain triglyceride supplements. Surgery is reserved for refractory cases. We present the case of a 66-year-old patient with a diagnosis of chylous ascites secondary to retroperitoneal lymphadenectomy.
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Galam P, Mundakal JK. Chylous ascites in a case of henoch-schonlein purpura - A case report and literature review. Ann Afr Med 2022; 21:305-308. [PMID: 36412327 PMCID: PMC9850884 DOI: 10.4103/aam.aam_168_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chylous ascites is a rare form of ascites characterized by the accumulation of lymph fluid in the peritoneal cavity. Henoch-Schonlein purpura (HSP) is a form of vasculitis usually seen in children affecting small vessels. Gastrointestinal (GI) manifestations of HSP are coming to the forefront as a presenting symptom. The presence of a rash usually succeeds the GI manifestations, making diagnosis difficult and leading to unnecessary surgical interventions. Our case shows a 38-year-old female who presented with an acute abdomen followed by an erythematous rash noticed later on, with radiological investigations suggestive of acute appendicitis. Chylous ascites was found as an incidental finding on diagnostic laparoscopy with a healthy appendix.
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Affiliation(s)
- Pushkar Galam
- Department of General Surgery, Dr. D. Y. Patil Medical College and Research Centre, Pimpri, Pune, Maharashtra, India
| | - Joseph Kurian Mundakal
- Department of General Surgery, Dr. D. Y. Patil Medical College and Research Centre, Pimpri, Pune, Maharashtra, India,Address for correspondence: Dr. Joseph Kurian Mundakal, Department of General Surgery, Dr. D. Y. Patil Medical College and Research Centre, Pimpri, Pune, Maharashtra, India. E-mail:
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Hattori Y, Yamashita S, Furuse K, Nakatsukasa S, Iida T. Lymphatic-venous anastomosis for the treatment of refractory lymphatic ascites following radiation therapy: A case report. Microsurgery 2021; 42:376-380. [PMID: 34967462 DOI: 10.1002/micr.30857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/09/2021] [Accepted: 12/22/2021] [Indexed: 02/01/2023]
Abstract
Radical treatments for intra-abdominal malignancies disturb physiological lymphatic drainage and predispose the patients to lymphatic complications such as lymphatic ascites. Despite its infrequent occurrence, lymphatic ascites is a morbid complication, and a definitive treatment protocol for refractory cases has not been established. Surgical treatments are opted depending on the etiology, symptoms, and facility equipment. Lymphatic-venous anastomosis (LVA) bypasses the proximal lymphatic blockages and provides an alternative route for lymphatic fluid recirculation into the venous system, thereby improving the lymphatic congestion. Herein, we report the utility of LVA surgery in the treatment of refractory serous lymphatic ascites that developed after radiation therapy for cervical cancer in a 77-year-old woman. The patient had massive ascites and suffered from abdominal distention and anorexia for 1 year. The ascites was unresponsive to conservative treatment. Under local anesthesia, eight incisions were made in the lower extremities just above the lymphatic channels that were identified by indocyanine green lymphography, and a total of 14 LVAs were created. The postoperative course was uneventful, and the ascites improved significantly. The patient remained free from the recurrence of ascites during 3.5 years of postoperative follow-up. LVA surgery was effective for the improvement and long-term control of lymphatic ascites. This procedure may be a viable option for the management of lymphatic ascites.
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Affiliation(s)
- Yoshitsugu Hattori
- Department of Plastic Surgery, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
| | - Shuji Yamashita
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kiichi Furuse
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shuichi Nakatsukasa
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Takuya Iida
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
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Wang X, Zheng Z, Chen M, Huang S, Lu X, Huang Y, Chi P. Chylous ascites has a higher incidence after robotic surgery and is associated with poor recurrence-free survival after rectal cancer surgery. Chin Med J (Engl) 2021; 135:164-171. [PMID: 34954713 PMCID: PMC8769138 DOI: 10.1097/cm9.0000000000001809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Postoperative chylous ascites is an infrequent condition after colorectal surgery and is easily treatable. However, its effect on the long-term oncological prognosis is not well established. This study aimed to investigate the short-term and long-term impact of chylous ascites treated with neoadjuvant therapy followed by rectal cancer surgery and to evaluate the incidence of chylous ascites after different surgical approaches. METHODS A total of 898 locally advanced rectal cancer patients treated with neoadjuvant chemoradiotherapy followed by surgery between January 2010 and December 2018 were included. The clinicopathological data and outcomes of the patients with chylous ascites were compared with those of the patients without chylous ascites. The primary endpoint was recurrence-free survival (RFS). To balance baseline confounders between groups, propensity score matching (PSM) was performed for each patient with a logistic regression model. RESULTS Chylous ascites was detected in 3.8% (34/898) of the patients. The incidence of chylous ascites was highest after robotic surgery (6.9%, 6/86), followed by laparoscopic surgery (4.2%, 26/618) and open surgery (1.0%, 2/192, P = 0.021). The patients with chylous ascites had a significantly higher number of lymph nodes harvested (15.6 vs. 12.8, P = 0.009) and a 3-day longer postoperative hospital stay (P = 0.017). The 5-year RFS rate was 64.5% in the chylous ascites group, which was significantly lower than the rate in the no chylous ascites group (79.9%; P = 0.007). The results remained unchanged after PSM was performed. The chylous ascites group showed a nonsignificant trend towards a higher peritoneal metastasis risk (5.9% vs. 1.6%, P = 0.120). Univariate analysis and multivariate analysis confirmed chylous ascites (hazard ratio= 3.038, P < 0.001) as an independent negative prognostic factor for RFS. CONCLUSIONS Considering the higher incidence of chylous ascites after laparoscopic and robotic surgery and its adverse prognosis, we recommend sufficient coagulation of the lymphatic tissue near the vessel origins, especially during minimally invasive surgery.
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Affiliation(s)
- Xiaojie Wang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Zhifang Zheng
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Min Chen
- Department of Obstetrics, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Shenghui Huang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Xingrong Lu
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Ying Huang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Pan Chi
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China
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Alrabadi A, Ihmeidan M, Al Demour S. Conservative management of chylous leak after open radical nephrectomy in an adult patient: a case report and literature review. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-020-00116-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Chylous ascites is rare but still a recognized complication of retroperitoneal surgeries caused mostly by inadvertent trauma to lymphatic channels. In this article, we present a case report and literature review of adult patient, with malignant tumor of upper urinary tract, who developed chylous leak after open nephrectomy.
Case presentation
We present a case of chylous leak for a 67-year-old female patient, presented to urology clinic with complaining of left loin pain and gross hematuria, found to have upper urinary tract tumor, she underwent open radical nephrectomy with lymph nodes dissection, and postoperatively she had chylous leak that is treated conservatively using octreotide and spironolactone without the need for total parenteral nutrition.
Conclusion
Conservative management should always be the first choice of management of chylous leak and chylous ascites. Careful anatomical identification and securing of the periaortic lymphatics are needed to decrease the risk of postoperative chylous leak and ascites.
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Zheng HD, Liu YR, Chen ZZ, Sun YF, Xu CH, Xu JH. Nomogram for predicting chylous ascites after right colectomy. World J Gastrointest Surg 2021; 13:1361-1371. [PMID: 34950426 PMCID: PMC8649560 DOI: 10.4240/wjgs.v13.i11.1361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/01/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chylous ascites following right colectomy has a high incidence which is a critical challenge. At present, there are few studies on the factors affecting chylous ascites after right colectomy and especially after D3 Lymphadenectomy. A predictive model for chylous ascites has not yet been established. Therefore, we created the first nomogram to predict the incidence of chylous ascites after right hemicolectomy.
AIM To analyze the risk factors for chylous ascites after right colectomy and establish a nomogram to predict the incidence of chylous ascites.
METHODS We retrospectively collected patients who underwent right hemicolectomy between January 2012 and May 2021 and were pathologically diagnosed with cancer. Multivariate logistic regression was used to analyze the influencing factors of chylous ascites and a nomogram was established. The predictive ability was assessed by the area under the receiver operating characteristic (ROC) curve.
RESULTS Operative time, the type of operation (standard or extended), the number of lymph nodes retrieved, and somatostatin administration were considered important risk factors. Multivariate logistic regression and nomograms can be used to accurately predict whether chylous ascites occurs. The area under the ROC curve of the model is 0.770. The C-statistic of this model is 0.770 which indicates that it has a relatively moderate ability to predict the risk of chylous ascites.
CONCLUSION We found a novel set of risk factors, created a nomogram, and validated it. The nomogram had a relatively accurate forecasting ability for chylous ascites after right hemicolectomy and can be used as a reference for risk assessment of chylous ascites and whether to prevent it after surgery.
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Affiliation(s)
- Hui-Da Zheng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Yu-Rong Liu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Zhen-Ze Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Ya-Feng Sun
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Chun-Hao Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Jian-Hua Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
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Morosin T, De Robles MS. Chylous ascites as a marker for intestinal viability in a small bowel obstruction: a case report. J Surg Case Rep 2021; 2021:rjab411. [PMID: 34594490 PMCID: PMC8478472 DOI: 10.1093/jscr/rjab411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022] Open
Abstract
Chylous ascites (CA) is the uncommon extravasation of triglyceride-rich fluid into the abdominal cavity as a result of the disruption of the abdominal lymphatic system. A patient who had previously undergone a subtotal colectomy presented with a closed-loop small bowel obstruction (SBO), underwent an emergency laparotomy with adhesiolysis and had intra-operative findings of milky intra-abdominal free fluid confirmed on analysis as CA. His post-operative period was complicated by a prolonged ileus, and following resolution, he was subsequently discharged home. Here, we present a case of a closed-loop SBO in which CA may be an indicator of intestinal viability.
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Affiliation(s)
- Tia Morosin
- Department of Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - M Shella De Robles
- Department of Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia
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An unusual complication of tumor surgery: chylous leakage. Surg Today 2021; 52:330-336. [PMID: 34223990 DOI: 10.1007/s00595-021-02334-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/24/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE This study was designed to evaluate the effectiveness of conservative treatment for chylous leak after tumor surgery and to propose a management algorithm. METHODS The data of patients with postoperative chylous leak after tumor surgery in our institution between 2010 and 2019 were retrospectively reviewed. In this study, 469 laparotomies, 89 thoracotomies, and 57 cervical excisions were performed for tumor surgery in our institution. RESULTS Twelve patients with a median age of 4 (IQR, 3-8) years had postoperative chylous leak. All patients received total parenteral nutrition for a median of 13 days. Five patients had intravenous somatostatin for a median of 14 days (IQR, 9-16) to decrease chyle production. Eventually, chylous leak ceased in all patients with conservative treatment and surgical drains were removed after no leak was observed with enteral feeding. CONCLUSIONS The incidence of chylous leak in childhood tumor surgery is approximately 2%. Extended tumor resection and lymph node dissection lead to the injury of the delicate structures that drain chyle. Conservative treatment with total parenteral nutrition and somatostatin seems to be effective. In particular, somatostatin may be used in resistant cases. Conservative treatment can take up to 1 month. The algorithm consists of how to manage postoperative chylous leak in childhood.
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Brewer CF, Al-Abed Y. Chyle leak following total colectomy for ulcerative colitis: a case report and review of the literature. Ann R Coll Surg Engl 2021; 103:e231-e233. [PMID: 34192489 DOI: 10.1308/rcsann.2020.7112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chyle leak is a rare complication in colorectal surgery. It occurs due to disruption of the lymphatic drainage network in the abdomen or retroperitoneum. We describe the first reported case of chyle leak following total colectomy for inflammatory bowel disease. Our patient underwent total colectomy for severe ulcerative colitis not responsive to medical treatment. Four days postoperatively, a milky fluid was noted in the drainage bag. Analysis of the fluid confirmed chyle. The patient remained well and was successfully managed conservatively with a fat-free elemental diet and was discharged from hospital on day 12 postoperatively. A review of the literature suggests that conservative management with dietary modification is a common and effective management strategy; however, medical and surgical options exist for refractory cases.
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Affiliation(s)
- C F Brewer
- Broomfield University Hospital, Mid and South Essex NHS Foundation Trust, UK
| | - Y Al-Abed
- Broomfield University Hospital, Mid and South Essex NHS Foundation Trust, UK
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Takata K, Nakazawa T, Miyagi M, Saito W, Imura T, Shirasawa E, Kuroda A, Kawakubo A, Mimura Y, Yokozeki Y, Takaso M, Inoue G. Chylous retroperitoneum following 720 degree anteroposterior-combined corrective surgery for adult spinal deformity with split vertebral fracture subluxation: a case report. Spine Deform 2021; 9:1183-1189. [PMID: 33651339 DOI: 10.1007/s43390-021-00309-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 02/08/2021] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN Clinical case report. PURPOSE To report the rare case with post-operative chylous retroperitoneum after corrective surgery for adult spinal deformity. METHODS We present a case of a 73-year-old woman with Parkinson's disease. She sustained a severe split fracture subluxation of the L3 vertebra with AO Spine Thoracolumbar classification type CN2M2, resulting in severe kyphoscoliosis in global alignment. She underwent a two-stage 720-degree anteroposterior-combined corrective surgery with anterior vertebral column resection of L3 and posterior fusion from T4 to the pelvis. On post-operative day 1, milky fluid in the drainage tube was noted, which was diagnosed as post-operative chylous retroperitoneum. RESULTS Oral intake was discontinued immediately and peripheral parenteral nutrition was started. A low-fat, high-protein diet was started on post-operative day 4, and drainage was removed on day 6. A low-fat diet was continued until 3 months post-operatively, with dietary counselling by a nutritionist. The chylous retroperitoneum resolved without recurrence at the final follow-up evaluation at 3 years. CONCLUSION Surgeons should recognize this rare complication, which might be induced by direct damage to the lymphatic flow during an operative maneuver anterior to the lumbar vertebral body and indirect damage due to shearing force during correction of a subluxated vertebra, especially in cases with a severe deformity.
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Affiliation(s)
- Ken Takata
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Toshiyuki Nakazawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Wataru Saito
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Takayuki Imura
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Eiki Shirasawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Akiyoshi Kuroda
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Ayumu Kawakubo
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yusuke Mimura
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yuji Yokozeki
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
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Mitchell K, Weiner A, Ramsay P, Sahni M. Use of Propranolol in the Treatment of Chylous Effusions in Infants. Pediatrics 2021; 148:peds.2020-049699. [PMID: 34187907 DOI: 10.1542/peds.2020-049699] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 11/24/2022] Open
Abstract
Chylothorax and chyloperitoneum are rare in infants and challenging to definitively diagnose by using current criteria extrapolated from the adult population. They can be of primary or secondary etiologies, including congenital lymphatic malformations and postoperatively, after cardiothoracic or abdominal surgery. Current first-line management consists of bowel rest, parenteral nutrition, and a modified diet of medium-chain triglycerides but can often take weeks to be effective. Off-label use of octreotide has been reported in numerous case studies for the management of chylous effusions. However, there are no definitive neonatal data available regarding dosing, safety, and efficacy; moreover, octreotide has a side effect profile that been linked to serious morbidities, such as pulmonary hypertension and necrotizing enterocolitis. Propranolol, commonly used for the treatment of infantile hemangiomas, is currently gaining interest as a novel therapy for chylous effusions. In this case series review, we describe the use of propranolol in 4 infants with presumed chylous effusions: 1 with congenital pleural effusions and 3 infants who developed postoperative chylothorax and/or chylous ascites. Clinical improvement was noted within a few days of initiating oral propranolol, and the maximum dose used in our cases was 6 mg/kg per day. In previous case reports, researchers describe the use of oral propranolol in infants with chylous effusions, with the dose used ranging from 0.5 to 4 mg/kg per day. However, this is the first case series in which researchers report its use exclusively in infants with chylothorax and chyloperitoneum. Although further research is needed to establish safety and efficacy, our experiences suggest that propranolol could be an acceptable treatment option for chylous effusions in infants.
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Affiliation(s)
- Kaitlin Mitchell
- Sunrise Children's Hospital, Pediatrix Medical Group of Nevada, Las Vegas, Nevada
| | - Angela Weiner
- Sunrise Children's Hospital, Pediatrix Medical Group of Nevada, Las Vegas, Nevada.,Department of Pediatrics, University of Nevada, Las Vegas, Nevada
| | - Patricia Ramsay
- Sunrise Children's Hospital, Pediatrix Medical Group of Nevada, Las Vegas, Nevada.,Department of Pediatrics, University of Nevada, Las Vegas, Nevada
| | - Mitali Sahni
- Sunrise Children's Hospital, Pediatrix Medical Group of Nevada, Las Vegas, Nevada .,Department of Pediatrics, University of Nevada, Las Vegas, Nevada
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Kakinuma D, Kanazawa Y, Matsuno K, Masuda Y, Ando F, Hagiwara N, Fujita I, Nomura T, Yoshiyuki T, Kato S, Yoshida H. Ligation and Fibrin Glue Spraying for Intractable Chylous Ascites after Radical Gastrectomy for Gastric Cancer: Case Report and Literature Review. J NIPPON MED SCH 2021; 88:242-247. [PMID: 32863341 DOI: 10.1272/jnms.jnms.2021_88-310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chylous ascites associated with radical resection of gastric cancer is a serious clinical condition. Lymph node dissection is indispensable during gastrectomy for gastric cancer. However, postoperative chylous ascites prolongs the hospital stay and re-operation. There are few reports on this subject. Most cases of chylous ascites resolve without treatment, but the condition can result in substantial morbidity. The definition of chylous ascites is ambiguous and varies in the English literature. In this report, we discuss a case of chylous ascites in a 68-year-old man who underwent distal gastrectomy for early gastric cancer at our hospital. He was admitted 8 months after surgery with a main complaint of abdominal swelling. Abdominal puncture helped to diagnose chylous ascites with marked elevation of triglyceride level. The patient received a hypercaloric infusion through a central line, and octreotide acetate, but did not improve. After assessment of lymph outflow by lymph scintigraphy, surgical ligation of the lymph vessels was performed through laparotomy. The volume of milky-white ascites in the abdominal cavity was 3,000 mL. Macroscopically, the fluid was confirmed as flowing from behind the common hepatic artery. Thus, ligation was performed. Chylous ascites has not recurred at 12 months after the re-operation. In summary, a case of chylous ascites after radical gastrectomy for gastric cancer was successfully treated by surgery. We review and discuss the relevant literature.
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Affiliation(s)
- Daisuke Kakinuma
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Yoshikazu Kanazawa
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Kunihiko Matsuno
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Yuka Masuda
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Fumihiko Ando
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Nobutoshi Hagiwara
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Itsuo Fujita
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Tsutomu Nomura
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Toshiro Yoshiyuki
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Shunji Kato
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
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MELO N, OLIVEIRA D, GOMES F, ALMEIDA J. Chylous ascites: a 5-year retrospective study. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2021. [DOI: 10.23736/s0393-3660.20.04456-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Successful minimal invasive treatment of chylous ascites following pancreaticoduodenectomy: A case report and review of literature. Ann Med Surg (Lond) 2021; 66:102451. [PMID: 34141422 PMCID: PMC8188255 DOI: 10.1016/j.amsu.2021.102451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Chylous ascites is an uncommon but potentially life-threatening type of postoperative lymphatic leakage, especially following pancreaticoduodenectomy. Case presentation A 59-year-old man underwent pancreaticoduodenectomy (PD) with extended lymphadenectomy and segmental Superior Mesenteric Vein (SMV) resection for SMV-involved pancreatic ductal adenocarcinoma (PDAC). After 20th postoperative day, patient had a drain output with a milky appearance, and with a triglyceride level was 1.6 mmol/L, and the daily output volume was up to 1500 mL per day. She has been performed Conventional Lymphangiography (CLAG) to identify the broken lymphatic vessels as well as close the leakage. Following two consecutive lymphangiography, the source of chylous leakage was identified from hilar lymphatic system, and injection of Aetoxisclerol 2% into lymphatic vessels to close the leakage was performed. Partial parenteral nutrition with limited fat components or medium-chain triglyceride (MCT) was administered, and the amount of ascites decreased particularly. The drain was removed in 20th day after the second CLAG. He had no symptoms of abdominal distention after drain removal and had been discharged after 37 postoperative days (PODs). Discussion Chylous ascites is an uncommon but potentially life-threatening complication following pancreaticoduodenectomy. Portal lymphatic plexus, which was often isolated and dissected especially with extended lymphadenectomy, is potentially damaged and caused resistant chylous leakage. Newly techniques are updated and applied in diagnosis and treatment for this difficult-to-treat complication, one of them is percutaneous transhepatic Conventional Lymphangiography (CLAG). Conclusion CLAG with percutaneous transhepatic access could be effective to identify and terminate the chylous fistula from portal lymphatic plexus after pancreaticoduodenectomy.
Chylous ascites is a potentially life-threatening type of lymphatic leakage, following pancreaticoduodenectomy. Portal lymphatic plexus was a potential location of lymphatic fistula due to the regularity of isolation and dissection in pancreaticoduodenectomy with extended lymphadenectomy. Conventional Lymphangiography (CLAG) is an invasion to identify the broken lymphatic vessels and close the leakage. Percutaneous transhepatic CLAG is a technique to puncture the portal lymphatic vessels, which could not be approached with other methods.
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Athanasiadis DI, Carr RA, Painter R, Selzer D, Lee NK, Banerjee A, Stefanidis D, Choi JN. Chylous ascites in the setting of internal hernia: a reassuring sign. Surg Endosc 2021; 36:2570-2573. [PMID: 33988770 DOI: 10.1007/s00464-021-08545-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/04/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chylous ascites is often reported in cases with lymphatic obstruction or after lymphatic injuries such as intraabdominal malignancies or lymphadenectomies. However, chylous ascites is also frequently encountered in operations for internal hernias. We sought to characterize the frequency and conditions when chylous ascites is encountered in general surgery patients. METHODS Data from patients who underwent operations for CPT codes related to open and laparoscopic abdominal and gastrointestinal surgery in our tertiary hospital from 2010 to 2019 were reviewed. Patients with the postoperative diagnosis of internal hernia were identified and categorized into three groups: Internal Hernia with chylous ascites, non-chylous ascites, and no ascites. Demographics, prior surgical history, CT findings, source of internal hernia, open or laparoscopic surgery, and preoperative labs were recorded and compared. RESULTS Fifty-six patients were found to have internal hernias and were included in our study. 80.3% were female and 86% had a previous Roux-en-Y gastric bypass procedure (RYGBP). Laparoscopy was the main approach for all groups. Ascites was present in 46% of the cases. Specifically, chylous ascites was observed in 27% of the total operations and was exclusively (100%) found in patients with gastric-bypass history. Furthermore, it was more commonly associated with Petersen's defect (p < 0.001), while the non-chylous fluid group was associated with herniation through the mesenteric defect (p < 0.001). CONCLUSIONS Chylous ascites is a common finding during internal hernia operations. Unlike other more morbid conditions, identification of chylous ascites during an internal hernia operation appears innocuous. However, in the context of a patient with a history of RYGBP, the presence of chylous fluid signifies the associated small bowel obstruction is likely related to an internal hernia through a patent Petersen's defect.
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Affiliation(s)
- Dimitrios I Athanasiadis
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 122, Indianapolis, IN, 46202, USA
| | - Rosalie A Carr
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 122, Indianapolis, IN, 46202, USA
| | - Robert Painter
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Don Selzer
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 122, Indianapolis, IN, 46202, USA
| | - Nicole Kissane Lee
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 122, Indianapolis, IN, 46202, USA
| | - Ambar Banerjee
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 122, Indianapolis, IN, 46202, USA
| | - Dimitrios Stefanidis
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 122, Indianapolis, IN, 46202, USA
| | - Jennifer N Choi
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 122, Indianapolis, IN, 46202, USA.
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Leaning M. Chylous ascites as a sequelae of primary small bowel volvulus in a virgin abdomen. J Surg Case Rep 2021; 2021:rjab176. [PMID: 33981409 PMCID: PMC8104944 DOI: 10.1093/jscr/rjab176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
Chylous ascites (CA) results in a thick white ascitic fluid, akin to milk. It is most commonly caused by malignancy and cirrhosis in adults. Here we present only the second reported case of primary small bowel volvulus resulting in CA in the virgin abdomen. The patient presented with acute onset, severe abdominal pain. She underwent an urgent laparotomy where a large volume of CA was drained. The bowel and its mesentery were congested with chyle and stained white. Following detorsion the bowel returned to normal, and the patient recovered well. Here we review the radiological findings and aetiology of CA, due to small bowel volvulus. This case highlights the importance of timely surgical intervention in patients with volvulus to prevent irreversible bowel ischaemia and if untreated, perforation.
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Affiliation(s)
- Matthew Leaning
- Department of General Surgery, Caboolture Hospital, Caboolture, Queensland, Australia
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