Chylous ascites. Newer insights and many remaining enigmas

We introduce a case of a 73-year-old man who developed intractable chylous ascites due to portal vein compression as a result of peripancreatic inflammatory changes after acute biliary pancreatitis. After stenting the portal vein stenosis, the chylous ascites improved from requiring weekly paracentesis to requiring no drainage within 4 months of the procedure and at the 15-month follow-up. To our knowledge, it is the first case reported in the literature where portal vein stenting has successfully been used to treat pancreatitis-induced chylous ascites.

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Combined Chylothorax and Chylous Ascites Complicating Liver Transplantation: A Report of a Case and Review of the Literature

Case Reports in Transplantation ◽

10.1155/2019/9089317 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Tommy Ivanics ◽

Semeret Munie ◽

Hassan Nasser ◽

Shravan Leonard-Murali ◽

Atsushi Yoshida ◽

...

Keyword(s):

Liver Transplantation ◽

Enteral Feeding ◽

Early Recognition ◽

Medium Chain Triglyceride ◽

Serum Triglyceride ◽

Chylous Ascites ◽

Abdominal Distension ◽

Invasive Treatment ◽

Management Options ◽

Early Enteral Feeding

Chyle leaks may occur as a result of surgical intervention. Chyloperitoneum, or chylous ascites after liver transplantation, is rare and the development of chylothorax after abdominal surgery is even more rare. With increasingly aggressive surgical resections, particularly in the retroperitoneum, the incidence of chyle leaks is expected to increase in the future. Here we present a unique case of a combined chylothorax and chyloperitoneum following liver transplantation successfully managed conservatively. Risk factors for chylous ascites include para-aortic manipulation, extensive retroperitoneal dissection, use of a Ligasure device, and early enteral feeding as well as early enteral feeding. The clinical presentation is typically insidious and may include painless abdominal distension. Diagnosis can be made by noting characteristic milky white drainage which on laboratory examination has a total fluid triglyceride level >110 mg/dl, an ascites/serum triglyceride ratio of >1 and a leukocyte count in fluid >1000/uL with a lymphocyte predominance. Chyle leaks may lead to significant morbidity and mortality. Numerous management options exist, with conservative nonoperative measurements leading to the most consistent and successful outcomes. This includes a step-up approach beginning with dietary modifications to a low-fat or medium chain triglyceride diet followed by nil per os with addition of total parenteral nutrition and somatostatin analogues such as octreotide. Rarely do patients require more invasive treatment. Early recognition and appropriate management are imperative to mitigate this complication.

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Chylous Ascites, Unusual Association with Ductal Pancreatic Adenocarcinoma with Plasmacytoid Morphology: A Case Report and Literature Review

The Surgery Journal ◽

10.1055/s-0041-1728651 ◽

2021 ◽

Vol 07 (03) ◽

pp. e158-e162

Author(s):

Catalin Bogdan Satala ◽

Ioan Jung ◽

Tivadar Jr. Bara ◽

Vlad Tudorache ◽

Simona Gurzu

Keyword(s):

Pancreatic Cancer ◽

Tumor Cells ◽

Surgical Intervention ◽

Chylous Ascites ◽

Distal Portion ◽

Ductal Adenocarcinoma ◽

Lymph Vessels ◽

Lymphangiosis Carcinomatosa ◽

Ductal Pancreatic Adenocarcinoma ◽

Tumor Emboli

AbstractChylous ascites represents a relatively uncommon condition. In this paper, we present a case of chyloperitoneum associated with pancreatic ductal adenocarcinoma (PDAC) and a review of literature regarding chylous ascites. A 76-year-old male patient was admitted in emergency department with acute abdomen. A pancreatic cancer was suspected. Subtotal spleno-pancreatectomy, for a nodular mass infiltrating the mild and distal portion of the pancreas, was necessary. During surgical intervention in the peritoneal cavity, a moderate quantity of whitish and thick consistency fluid with milk-like appearance was observed to be accumulated. After examination of the fluid, chyloperitoneum was diagnosed. The histologic examination showed a PDAC, with multiple emboli in lymph vessels, with tumor cells with plasmacytoid morphology, diagnosed as lymphangiosis carcinomatosa. The patient died at 3 weeks after surgical intervention. In patients with pancreatic cancer and chylous ascites, suspicion of tumor-related blockage of the lymphatic flow should be suspected. Prognosis of PDAC should be evaluated not only based on the number of lymph node metastases, but also considering the number of lymph vessels with tumor emboli and the architecture of tumor cells. This is the first reported case of a PDAC with plasmacytoid morphology of lymphangiosis carcinomatosa.

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Chylous Ascites Presenting as an Acute Abdomen After Sleeve Gastrectomy

The American Surgeon ◽

10.1177/0003134821991986 ◽

2021 ◽

pp. 000313482199198

Author(s):

Helen B Buschel ◽

Samuel P Baker ◽

John Avramovic

Keyword(s):

Sleeve Gastrectomy ◽

Acute Abdomen ◽

Chylous Ascites

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Application of ultrasound-guided intranodal lymphangiography and embolisation in cancer patients with postoperative lymphatic leakage

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02144-2 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Xingwei Sun ◽

Feng Zhou ◽

Xuming Bai ◽

Qiang Yuan ◽

Mingqing Zhang ◽

...

Keyword(s):

Cancer Patients ◽

Operative Time ◽

Length Of Hospital Stay ◽

Chylous Ascites ◽

Pelvic Surgery ◽

Ultrasound Guided ◽

Technical Success Rate ◽

Life Threatening ◽

Low Incidence ◽

Intranodal Lymphangiography

Abstract Background Traumatic lymphatic leakage is a rare but potentially life-threatening complication. The purpose of this study was to introduce ultrasound-guided intranodal lymphangiography and embolisation techniques for postoperative lymphatic leakage in patients with cancer. Methods From January 2018 through June 2020, seven cancer patients (three males, four females, aged 59–75 years [mean 67.57 ± 6.11 years]) developed lymphatic leakage after abdominal or pelvic surgery, with drainage volumes ranging from 550 to 1200 mL per day. The procedure and follow-up of ultrasound-guided intranodal lymphangiography and embolisation were recorded. This study retrospectively analysed the technical success rate, operative time, length of hospital stay, clinical efficacy, and complications. Results The operation was technically successful in all patients. Angiography revealed leakage, and embolisation was performed in all seven patients (7/7, 100%). The operative time of angiography and embolisation was 41 to 68 min, with an average time of 53.29 ± 10.27 min. The mean length of stay was 3.51 ± 1.13 days. Lymph node embolisation was clinically successful in five patients (5/7, 71.43%), who had a significant reduction in or disappearance of chylous ascites. The other two patients received surgical treatment 2 weeks later due to poor results after embolisation. All patients were followed for 2 weeks. No serious complications or only minor complications were found in all the patients. Conclusions Ultrasound-guided intranodal lymphangiography and embolisation were well tolerated by the patients, who experienced a low incidence of complications. Early intervention is recommended for cancer patients with postoperative lymphatic leakage.

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