1/230. Surgical management of chylous fistula after retroperitoneal lymph node dissection. Conservative treatment with low-fat diet, medium-chain triglyceride or total parenteral nutrition, depending on the general condition of the patient, is the mainstay in the treatment of chylous ascites. In patients with persistent chylous fistula direct surgical closure is a valid treatment option. ( info) |
2/230. Chylous complications after abdominal aortic surgery. Two patients developed chylous complications following abdominal aortic aneurysm repair. One patient had chylous ascitis and was successfully treated by a peritoneo-caval shunt. The other patient developed a lymph cyst, which gradually resorbed after puncture. Chylous complications following aortic surgery are rare. patients in bad a general condition should be treated by initial paracentesis and total parenteral nutrition, supplemented by medium-chain triglyceride and low-fat diet. If no improvement is observed on this regimen, the next step should be implementation of a peritoneo-venous shunt, whereas direct ligation of the leak should be reserved for those who are not responding to this treatment. ( info) |
| chylous ascites is a rare form of ascites, the presence of which generally denotes a very poor long term prognosis. We report the case of a patient with acquired immune deficiency syndrome (AIDS) and massive chylous ascites secondary to mycobacterium avium complex (MAC) infection, identified in the ascitic fluid by a dna probe assay. With multidrug anti-MAC therapy the ascites resolved completely, and the patient has survived for >21 months. diagnosis and treatment of MAC-related chylous ascites are reviewed. ( info) |
4/230. Chyloperitoneum: a rare complication after abdominal aortic aneurysm repair. We report a case of chylous ascites as a rare complication following elective aortic aneurysm repair in a 66-year-old male. After early development of this condition on the second postoperative day, relaparotomy was performed with ligation of fistulae as well as omentoplasty. After recurrence of chylous ascites, conservative treatment consisting of parenteral nutrition and a low-fat diet for 3 months along with continuous peritoneal drainage finally led to successful resolution of this complication. ( info) |
5/230. Lymphatic malformation causing intractable chylorrhagia. Lymphatic malformation is a developmental error usually noticed at birth or in early childhood. Lesions of the upper leg and lower trunk are the most difficult to remove, because they are often the largest ones encountered and also because they tend to extend proximally into the retroperitoneal tissues. chyle reflux, usually associated with lymphedema of the extremity, has not been reported to be caused by lymphatic malformation. We report a case of intrapelvic retroperitoneal lymphatic malformation with an extension of gluteal-thigh soft-tissue involvement causing intractable chylorrhagia. The tumor was subtotally excised, and the defect was closed by a distally based, peninsular latissimus dorsi myocutaneous flap. The flap served both as a filling material and as a "bridge" between the residual tumor, including abnormal lymphatics, and normal lymph flow. ( info) |
6/230. Isolated rupture of the cisterna chyli after blunt trauma. An 8-year-old boy was evaluated for blunt abdominal trauma after a motor vehicle crash. In the course of his workup, a computed tomography (CT) scan of the abdomen was suspicious for a duodenal injury. At surgery, the duodenum was found to be normal; however, a rupture of the cisterna chyli was identified. This injury was repaired, and the boy made an uneventful recovery. This report is one of few in the literature describing isolated injury to the cisterna chyli after blunt abdominal trauma. ( info) |
7/230. Transient chylous ascites following a distal splenorenal shunt. The development of chylous ascites following abdominal surgery is an infrequent yet alarming complication. We present a patient in whom chylous ascites was diagnosed 6 days after a distal splenorenal shunt. Ten days following bed rest, sodium restriction, and a low-fat diet with medium-chain triglyceride supplementation the ascites resolved. ( info) |
8/230. Treatment of chyloperitoneum after extended lymphatic dissection during duodenopancreatectomy. BACKGROUND: Chyloperitoneum is a rare postoperative complication that might be caused by an interruption of chylous ducts in the mesenteric root or the cysterna chyli. Two cases of chyloperitoneum after duodenopancreatectomy are reported in the literature. methods: We here report the third case that developed a chyloperitoneum 2 wk postoperatively when he resumed his normal diet. RESULTS: The patient was treated conservatively with paracenteses and chyloperitoneum subsided thereafter. CONCLUSIONS: Chyloperitoneum after extended duodenopancreatectomy might be treated conservatively. ( info) |
| chylous ascites is the accumulation of lymphatic fluid within the peritoneal cavity, due to trauma or obstruction to the lymphatic system. Postoperative chylous ascites is a rare complication of abdominal surgery. This is frequently reported after retroperitoneal dissections, and results in high morbidity and mortality. The treatment options are varied and include total parenteral nutrition (TPN), elemental diet with medium chain triglycerides (MCT), repeated paracentesis and surgical ligation. We report a case of post-operative chylous ascites after D2 distal gastrectomy. Treatment by fasting, TPN followed by fat-free diet resulted in complete resolution of ascites within 3 weeks. To our knowledge this is the first report of such a complication following radical gastrectomy. We review the literature and briefly discuss the management options. ( info) |
| chylous ascites due to constrictive pericarditis is an extremely rare clinical entity, possibly caused by the augmented lymph production and high impedance to lymph drainage due to central venous hypertension. The authors describe a patient with chylous ascites caused by constrictive pericarditis in the absence of lymphatic obstruction. cardiac catheterization is essential for the confirmation of accurate diagnosis of constrictive pericarditis. magnetic resonance imaging of the heart is also very helpful in the diagnosis. The patient was symptom free and his ascites and edema completely resolved after pericardiectomy. ( info) |