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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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Chen ZQ, Zeng SJ, Xu C. Management of chylous ascites after liver cirrhosis: A case report. World J Hepatol 2025; 17:100797. [PMID: 39871904 PMCID: PMC11736487 DOI: 10.4254/wjh.v17.i1.100797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 10/15/2024] [Accepted: 11/18/2024] [Indexed: 01/06/2025] Open
Abstract
BACKGROUND Chylous ascites is an uncommon condition, occurring in less than 1% of ascites cases. It results from traumatic or obstructive disruption of the lymphatic system, causing the leakage of thoracic or intestinal lymph into the abdominal cavity. This leads to the accumulation of a milky, triglyceride-rich fluid. In adults, malignancy and cirrhosis are the primary causes of chylous ascites. Notably, chylous ascites accounts for only 0.5% to 1% of all cirrhosis-related ascites cases. At present, there is a limited understanding of this condition, and effective timely management in clinical practice remains challenging. CASE SUMMARY This case report presents a patient with hepatic cirrhosis complicated by chylous ascites, who had experienced multiple hospitalizations due to abdominal distension. Upon admission, comprehensive examinations and assessments were conducted. The treatment strategy focused on nutritional optimization through a low-sodium, low-fat, and high-protein diet supplemented with medium-chain triglycerides, therapeutic paracentesis, and diuretics. Following a multidisciplinary discussion and thorough evaluation of the patient's condition, surgical indications were confirmed. After informing the patient about the benefits and risks, and obtaining consent, a transjugular intrahepatic portosystemic shunt procedure was performed, successfully alleviating the abdominal swelling symptoms. This article details the clinical characteristics and treatment approach for this uncommon case, summarizing current management methods for hepatic cirrhosis complicated by chylous ascites. The aim is to provide valuable insights for clinicians encountering similar situations. CONCLUSION Optimizing nutrition and addressing the underlying cause are essential in the treatment of chylous ascites. When conservative approaches prove ineffective, alternative interventions such as transjugular intrahepatic portosystemic shunt may be considered.
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Affiliation(s)
- Zong-Qiang Chen
- Department of Gastroenterology, Guangdong Medical University, Zhanjiang 524000, Guangdong Province, China
| | - Shu-Jun Zeng
- Department of Gastroenterology, Huizhou Central People's Hospital, Huizhou 516000, Guangdong Province, China
| | - Chun Xu
- Department of Gastroenterology, Huizhou Central People's Hospital, Huizhou 516000, Guangdong Province, China.
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Li Y, Tai Y, Wu H. Colon signet-ring cell carcinoma with chylous ascites caused by immunosuppressants following liver transplantation: A case report. World J Gastrointest Surg 2024; 16:2343-2350. [PMID: 39087099 PMCID: PMC11287694 DOI: 10.4240/wjgs.v16.i7.2343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/23/2024] [Accepted: 06/12/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND Chylous ascites is caused by disruption of the lymphatic system, which is characterized by the accumulation of a turbid fluid containing high levels of triglycerides within the abdominal cavity. The two most common causes are cirrhosis and tuberculosis, and colon signer ring cell carcinoma (SRCC) due to the use of immunosuppressants is extremely rare in cirrhotic patients after liver transplantation, making it prone to misdiagnosis and missed diagnosis. CASE SUMMARY A 52-year-old man who underwent liver transplantation and was administered with immunosuppressants for 8 months was admitted with a 3-month history of progressive abdominal distention. Initially, based on lymphoscintigraphy and lymphangiography, lymphatic obstruction was considered, and cystellar chyli decompression with band lysis and external membrane stripping of the lymphatic duct was performed. However, his abdominal distention was persistent without resolution. Abdominal paracentesis revealed allogenic cells in the ascites, and immunohistochemistry analysis revealed adenocarcinoma cells with phenotypic features suggestive of a gastrointestinal origin. Gastrointestinal endoscopy was performed, and biopsy showed atypical signet ring cells in the ileocecal valve. The patient eventually died after a three-month follow-up due to progression of the tumor. CONCLUSION Colon SRCC, caused by immunosuppressants, is an unusual but un-neglected cause of chylous ascites.
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Affiliation(s)
- Ying Li
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yang Tai
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hao Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Galvão D, Bettencourt R, Soares AC, Bagnari I, Bonança J. Rare Combination of Chyloperitoneum Secondary to Primary Small-Bowel Volvulus. Cureus 2024; 16:e53379. [PMID: 38435223 PMCID: PMC10907969 DOI: 10.7759/cureus.53379] [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: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Chylous ascites is the exudation from lymphatic content to the peritoneum and is a rare situation that mostly occurs following medical causes like neoplasms or cirrhosis. However, trauma to the lymphatic system due to compression by masses or altered anatomy can be a trigger too. We describe a rare combination of a primary small bowel volvulus in a young healthy adult causing chylous ascites. Obstruction caused by a primary small bowell volvulus can re-arrange the lymphatics anatomy increasing their flow pressure which can lead to rupture and leak. This is an emergent scenario that needs to be addressed quickly because of bowel ischaemia. CT scan is the gold standard to expedite diagnosis and go to surgical treatment. Although it can be an impactful finding, treatment of the cause behind chylous ascites results in complete resolution without any bowel resection.
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Affiliation(s)
- Diogo Galvão
- Surgery, Hospital de Santo Espírito da Ilha Terceira, Angra do Heroísmo, PRT
| | - Rui Bettencourt
- Surgery, Hospital de Santo Espírito da Ilha Terceira, Angra do Heroísmo, PRT
| | - Ana Cláudia Soares
- Surgery, Hospital de Santo Espírito da Ilha Terceira, Angra do Heroísmo, PRT
| | - Inês Bagnari
- Surgery, Hospital de Santo Espírito da Ilha Terceira, Angra do Heroísmo, PRT
| | - Joana Bonança
- Surgery, Hospital de Santo Espírito da Ilha Terceira, Angra do Heroísmo, PRT
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Fricke J, Wang J, Gallego N, Mambetsariev I, Kim P, Babikian R, Chen BT, Afkhami M, Subbiah V, Salgia R. Selpercatinib and Pralsetinib Induced Chylous Ascites in RET-Rearranged Lung Adenocarcinoma: A Case Series. Clin Lung Cancer 2023; 24:666-671. [PMID: 37580188 PMCID: PMC10840632 DOI: 10.1016/j.cllc.2023.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Jeremy Fricke
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center, Duarte, CA
| | - Joshua Wang
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center, Duarte, CA
| | | | - Isa Mambetsariev
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center, Duarte, CA
| | - Pauline Kim
- Department of Pharmacy, City of Hope National Medical Center, Duarte, CA
| | - Razmig Babikian
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center, Duarte, CA
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA
| | | | - Vivek Subbiah
- Department of Early-Phase Drug Development, Sarah Cannon Research Institute, Nashville, TN
| | - Ravi Salgia
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center, Duarte, CA.
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6
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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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7
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Shah ZA, Fatima K, Hamid H, Ilyas M, Nouman M, Zeb M. Acute pancreatitis with chylous ascites mimicking acute appendicitis: A rare case report. Int J Surg Case Rep 2023; 108:108462. [PMID: 37423146 PMCID: PMC10382834 DOI: 10.1016/j.ijscr.2023.108462] [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: 05/10/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Chylous ascites, characterized by the accumulation of lymphatic fluid in the peritoneal cavity, presents a significant diagnostic and management challenge, particularly in resource-limited settings. CASE PRESENTATION We report a case of a 63-year-old female with acute abdominal pain who was initially diagnosed with acute perforated appendicitis. During open surgery, Chylous ascites was found with normal appendix and bulky pancrease with surrounding fluid accumulation. Drain was placed in lesser sac area and appendectomy was performed with drain placed in right iliac fossa. Recovery was uneventful. CLINICAL DISCUSSION Chylous ascites can be challenging to diagnose, especially in resource-limited settings. Laboratory analysis and imaging studies play a critical role in establishing the diagnosis, while conservative measures and invasive interventions, if necessary, comprise the treatment strategy. CONCLUSION Our case highlights the importance of considering chylous ascites as a potential differential diagnosis in acute abdomen cases. Accurate diagnosis and management can be particularly challenging in resource-limited settings, and increased awareness among clinicians and further research is necessary to improve outcomes for patients.
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Affiliation(s)
| | | | | | | | | | - Muhammad Zeb
- General Surgery Department, Hayatabad Medical Complex, Peshawar, Pakistan.
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8
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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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9
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Duletzke NT, Kiraly LN, Martindale RG. Chylothorax and chylous ascites: Overview, management, and nutrition. Nutr Clin Pract 2023; 38:557-563. [PMID: 36938719 DOI: 10.1002/ncp.10973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 03/21/2023] Open
Abstract
Chyle leaks of any source or type can cause significant morbidity and mortality. Attention to the anatomy and physiology of the leak, followed by stepwise dietary and pharmacologic management, obviates the need for surgical intervention in a majority of patients. In this article, we review the importance, etiology, anatomy, diagnosis, nutrition and immunologic effects, and options for treatment of chylothorax and chylous ascites based on experience and prior literature. We propose a multidisciplinary approach to optimize these treatments including the primary surgical teams, pharmacists, and dietitians, with reoperation as a last resort to minimize the morbidity of this challenging complication.
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Affiliation(s)
- Nicholas T Duletzke
- Department of Surgery, Oregon Health and Science University, Oregon, Portland, USA
| | - Laszlo N Kiraly
- Department of Surgery, Oregon Health and Science University, Oregon, Portland, USA
| | - Robert G Martindale
- Department of Surgery, Oregon Health and Science University, Oregon, Portland, USA
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10
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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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11
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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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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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13
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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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14
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Mahajan A, Sankhyan P, Boonpheng B. Bilateral Chylothorax and Chylous Ascites: A Rare Presentation of an Uncommon Disorder. Cureus 2021; 13:e14044. [PMID: 33898130 PMCID: PMC8059777 DOI: 10.7759/cureus.14044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We describe the case of a 62-year-old female who presented with gradually progressing abdominal distension and dyspnea. Computed tomography (CT) chest and abdomen revealed large bilateral pleural effusions with large ascites, a mid-abdominal mass, and peritoneal carcinomatosis. Pleural and peritoneal tap revealed chylous fluid, and the biopsy findings from abdominal mass were consistent with follicular lymphoma. We then discuss a review of the literature and diagnoses for bilateral chylothorax and chylous ascites.
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Affiliation(s)
- Akhilesh Mahajan
- Pulmonary Critical Care, Lenox Hill Hospital, New York, USA.,Internal Medicine, East Tennessee State University, Johnson City, USA
| | - Pratyaksha Sankhyan
- Pulmonary Critical Care, East Carolina University, Greenville, USA.,Internal Medicine, East Tennessee State University, Johnson City, USA
| | - Boonphiphop Boonpheng
- Nephrology, University of California Los Angeles, Los Angeles, USA.,Internal Medicine, East Tennessee State University, Johnson City, USA
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Apikotoa S, Wijesuriya R. Idiopathic acute chylous peritonitis during pregnancy, mimicking perforated acute appendicitis: A case report. Int J Surg Case Rep 2021; 81:105790. [PMID: 33756169 PMCID: PMC8020439 DOI: 10.1016/j.ijscr.2021.105790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 11/11/2022] Open
Abstract
CA is extremely rare, especially in pregnancy, previously described in the setting of pancreatitis but can present as perforated appendicitis. In early pregnancy there is a diagnostic dilemma and once other sources of sepsis are excluded a diagnostic laparoscopy should be considered. During diagnostic laparoscopy fluid should be assessed for triglycerides, microscopy/culture/cytology and a potential precipitating agent. Medium fatty-chain acid diet with MCT oil supplementation and dietician input is crucial in management. Unclear role of antibiotics, on the balance of risk benefit it was deemed appropriate to administer antibiotics. Introduction and importance Chylous ascites (CA) is an extremely rare presentation in pregnancy and poses a diagnostic challenge in clinical practice. There have only been a few case reports of CA in pregnancy with the majority of cases found incidentally at the time of caesarean section or in the context of pancreatitis. Case presentation A 36-year-old female who was 13 weeks pregnant had clinically presented right iliac fossa pain with peritonitis and had signs of sepsis. Once other potential sources of sepsis were excluded, had proceeded to diagnostic laparoscopy performed by the treating consultant given there were no appropriate out-of-hours imaging modalities available. Clinical discussion This case report hopes to advocate for the effective intervention of a diagnostic laparoscopy in this setting and other important considerations for management during first trimester pregnancy. Upon diagnosis the patient was put onto a medium chain fatty acid diet with excellent outcomes post operatively and at the outpatient follow up. The case report has been reported in line with the SCARE 2020 criteria [11]. Conclusion Chylous ascites is a rare finding and additionally is even more rare to cause peritonism. What we found most interesting in this case is that in the absence of any other potential sources of infection, how chylous ascites not only presented with peritonism but prompted a septic response. Another pertinent issue is that in pregnancy we are limited with investigative options and therefore diagnosis will depend on the clinical presentation and decision for prompt diagnostic/therapeutic laparoscopy should be strongly considered.
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Affiliation(s)
- Sharie Apikotoa
- St John of God Hospital, Midland. 1 Clayton Street, Midland, 6056 Western Australia, Australia.
| | - Ruwan Wijesuriya
- St John of God Hospital, Midland. 1 Clayton Street, Midland, 6056 Western Australia, Australia.
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16
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Joshi AN, Valliani T, Przemioslo R. Unusual presentation of a man with recurrent chylous ascites. BMJ Case Rep 2021; 14:14/3/e235273. [PMID: 33674287 PMCID: PMC7939000 DOI: 10.1136/bcr-2020-235273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe an interesting case of a 77-year-old man presenting with refractory chylous ascites of unknown aetiology. After extensive diagnostic workup, unifying diagnosis of an intriguing condition of yellow nail syndrome was reached. This case is unusual as it describes a rare cause of chylous ascites in this age group. Despite refractory ascites and the need for recurrent paracentesis, this patient has a good prognosis with no significant impact on overall mortality.
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Affiliation(s)
- Alka N Joshi
- Gastroenterology and Hepatology, North Bristol NHS Trust, Bristol, UK
| | - Talal Valliani
- Gastroenterology and Hepatology, North Bristol NHS Trust, Bristol, UK
| | - Robert Przemioslo
- Gastroenterology and Hepatology, North Bristol NHS Trust, Bristol, UK
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17
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Santos E, Moussa AM. Chylous Ascites and Lymphoceles: Evaluation and Interventions. Semin Intervent Radiol 2020; 37:274-284. [PMID: 32773953 DOI: 10.1055/s-0040-1713445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Kinmonth introduced lymphangiography in 1955 and it became an important tool in the diagnosis and treatment of malignant disease. The technique, based on bipedal approach, was difficult and time-consuming which limited its use in clinical practice. Cope is the father of percutaneous lymphatic interventions and he was the first person to access and intervene on the lymphatic system. After his initial work published on 1999, there has been an expansion of the lymphatic embolization techniques, particularly since the development of intranodal lymphangiography and advance lymphatic imaging. This article is focused on the evaluation and management of postoperative chylous ascites and lymphoceles. Their incidence is growing due to longer survival of cancer patients and more radical surgical approaches, leading to an increased morbidity and mortality in this patient population. Minimally invasive percutaneous lymphatic embolization is becoming a first-line therapy in patients with postoperative lymphatic leakage.
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Affiliation(s)
- Ernesto Santos
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amgad M Moussa
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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18
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Kuetting D, Luetkens J, Fimmers R, Sprinkart AM, Attenberger U, Pieper CC. MRI Assessment of Chylous and Nonchylous Effusions: Use of Multipoint Dixon Fat Quantification. Radiology 2020; 296:698-705. [PMID: 32662762 DOI: 10.1148/radiol.2020200089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Diagnosis of chylous effusions normally requires invasive paracentesis. Purpose To assess whether MRI with multipoint Dixon fat quantification allows for noninvasive differentiation of chylous and nonchylous ascites and pleural effusions. Materials and Methods Phantom, ex vivo, and in vivo MRI examinations were performed by using a commercially available multipoint Dixon pulse sequence with a 1.5-T MRI system. Fat fraction values were measured with a region of interest-based approach on reconstructed maps. For phantom evaluation, eight titrated fatty fluid solutions (nonhuman samples) with varying triglyceride content (145-19 000 mg/dL [1.64-214.7 mmol/L]) were examined. For ex vivo evaluation, 15 chylous and five nonchylous study participant fluid samples were examined. In a prospective study performed from June 2016 to February 2018, 29 study participants with known chylous (n = 17) and nonchylous (n = 12) effusions were evaluated with MRI. All clinical samples underwent laboratory testing for triglyceride level, total protein level, white blood cells, and red blood cells. Laboratory values were correlated with fat fraction values; the optimal fat fraction threshold was determined to differentiate chylous and nonchylous fluids. Results Phantom analysis showed that fat fraction values correlated with triglyceride content (r = 0.99, P < .001). In ex vivo studies, multipoint Dixon-derived fat fraction was higher in chylous versus nonchylous fluids (mean, 2.5% ± 1.2 [standard deviation] vs 0.8% ± 0.2; P = .001). Fat fraction was correlated with triglyceride content (r = 0.96, P < .001). For in vivo studies, fat fraction was greater for chylous versus nonchylous fluids (mean, 6.2% ± 4.3 vs 0.6% ± 0.6; P < .001). In vivo fat fraction was correlated with triglyceride content (r = 0.96, P < .001). Use of a fat fraction cutoff value greater than 1.8% yielded a sensitivity of 14 of 17 (82% [95% confidence interval (CI): 57%, 97%]) and a specificity of 12 of 12 (100% [95% CI: 74%, 100%]) for differentiation of chylous and nonchylous effusions. Conclusion MRI can help identify chylous versus nonchylous ascites and pleural effusions through use of multipoint Dixon fat quantification. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Daniel Kuetting
- From the Department of Radiology (D.K., J.L., A.M.S., U.A., C.C.P.) and Department of Medical Biometry, Informatics, and Epidemiology (R.F.), University of Bonn, Venusberg Campus 1, 53105 Bonn, Germany
| | - Julian Luetkens
- From the Department of Radiology (D.K., J.L., A.M.S., U.A., C.C.P.) and Department of Medical Biometry, Informatics, and Epidemiology (R.F.), University of Bonn, Venusberg Campus 1, 53105 Bonn, Germany
| | - Rolf Fimmers
- From the Department of Radiology (D.K., J.L., A.M.S., U.A., C.C.P.) and Department of Medical Biometry, Informatics, and Epidemiology (R.F.), University of Bonn, Venusberg Campus 1, 53105 Bonn, Germany
| | - Alois M Sprinkart
- From the Department of Radiology (D.K., J.L., A.M.S., U.A., C.C.P.) and Department of Medical Biometry, Informatics, and Epidemiology (R.F.), University of Bonn, Venusberg Campus 1, 53105 Bonn, Germany
| | - Ulrike Attenberger
- From the Department of Radiology (D.K., J.L., A.M.S., U.A., C.C.P.) and Department of Medical Biometry, Informatics, and Epidemiology (R.F.), University of Bonn, Venusberg Campus 1, 53105 Bonn, Germany
| | - Claus C Pieper
- From the Department of Radiology (D.K., J.L., A.M.S., U.A., C.C.P.) and Department of Medical Biometry, Informatics, and Epidemiology (R.F.), University of Bonn, Venusberg Campus 1, 53105 Bonn, Germany
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Tai E, Min A, Rajan DK. A Single-Center Experience With Percutaneous Interventional Management of Refractory Chylous Ascites. Can Assoc Radiol J 2020; 72:871-875. [DOI: 10.1177/0846537120929429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: Management of chylous ascites is poorly understood with no management guidelines. We retrospectively reviewed patients treated for chylous ascites at our institution to evaluate efficacy and safety of lipiodol lymphangiography and embolization. Materials and Methods: Seven patients underwent percutaneous interventional management of chylous ascites (average age 52.5 years, 3 female, 6 post-surgical, 1 pancreatitis) from 2012. All patients underwent lipiodol inguinal lymph node injection. Adjunctive glue embolization was performed if a leak was identified. Data were collected on the cause of chylous ascites, conservative management strategies, procedural details, and success. Results: All patients had chylous ascites refractory to conservative management. Preprocedure lymphoscintigraphy identified a retroperitoneal leak in 6 patients. Seven patients underwent 12 lymphangiogram procedures; 8 were performed at our institution. Lymphangiography identified a leak in 5 patients (71%). Success was achieved in 2 patients (28%) treated at our institution after glue embolization following cannulation of the leaking lymphatic channels and 1 patient (14%) after lymphangiography alone for an overall success rate of 43% (3/7). Two patients (29%) were successfully treated after one procedure. Two patients (29%) unsuccessfully treated at our institution were referred to a specialized center in the United States. No 30 day post procedural complications. Conclusions: In our experience, lymphangiography and embolization was a safe, relatively effective and minimally invasive method for treating medically refractory chylous ascites. Complex cases required referral to a specialized institution with resources unavailable at our tertiary care center.
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Affiliation(s)
- Elizabeth Tai
- Division of Interventional Radiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Adam Min
- Division of Interventional Radiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Dheeraj K. Rajan
- Division of Interventional Radiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
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20
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Kim PH, Tsauo J, Shin JH. Lymphangiography with or without Embolization for the Treatment of Postoperative Chylous Ascites. Ann Vasc Surg 2020; 68:351-360. [PMID: 32439520 DOI: 10.1016/j.avsg.2020.04.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lymphatic interventions have recently been increasingly used for treating lymphatic leak of the abdomen and pelvis. This retrospective case study series and systematic review evaluated the efficacy and safety of lymphatic interventions for the treatment of postoperative lymphatic leak of the abdomen and pelvis. METHODS A total of 15 consecutive patients with postoperative lymphatic leak of the abdomen and pelvis treated with lymphatic interventions (i.e., diagnostic intranodal or pedal lymphangiography [LAG], i.e., potentially therapeutic or diagnostic LAG with intention to treat through embolization) at our institution were reviewed. The data of 72 patients from 13 relevant articles identified through a literature search of the MEDLINE/PubMed, EMBASE, and Cochrane databases were extracted. RESULTS The data of 87 patients (mean age, 59 [range, 24-84] years) were pooled. The technical success rate of LAG (intranodal approach, 78.2% [68/87]; pedal approach, 21.8% [19/87]) was 97.7% (85/87; 95% confidence interval [CI], 91.5-99.9%). Of the 85 patients in whom technical success of LAG was achieved, data on clinical success were available for 47 patients (55.3%). The clinical success rate of LAG was 68.1% (32/47; 95% CI, 53.8-79.7%). Of the 85 patients in whom technical success of LAG was achieved, 38 (44.7%) underwent embolization. The technical success rate of embolization was 97.4% (37/38; 95% CI, 85.3-99.9%). The clinical success rate of embolization was 70.3% (26/37; 95% CI, 54.1-82.6%). Major complications did not occur. The overall primary and secondary clinical success rates were 65.5% (57/87; 95% CI, 55.0-74.7%) and 78.2% (68/87; 95% CI, 68.3-85.6%), respectively. CONCLUSIONS Lymphatic interventions are safe and relatively effective adjunct to conservative therapy, with the primary and secondary clinical success rate of 65.5% and 78.2%, for postoperative lymphatic leak of the abdomen and pelvis.
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Affiliation(s)
- Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Jiaywei Tsauo
- Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
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21
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Mangal V, manrai M, Kumar A. Extramedullary hematopoiesis causing portal hypertension with chylous ascites in a patient with primary myelofibrosis. EUROPEAN JOURNAL OF MEDICAL CASE REPORTS 2020; 4. [DOI: 10.24911/ejmcr/173-1583099876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2024]
Abstract
Background:
Primary myelofibrosis is a rare myeloproliferative disorder that is occasionally associated with abdominal and hepatic complications, such as Budd–Chiari syndrome, nodular regenerative hyperplasia, portal vein thrombosis, and rarely portal hypertension, which is found in 7% of the cases.
Case Presentation:
We report a rare case of portal hypertension with chylous ascites in a 49-year-old male patient with primary myelofibrosis, who presented with a painless progressive distension of the abdomen for 1 month. His transjugular liver biopsy revealed extramedullary hematopoiesis with colonies of erythroid precursors, megakaryocytes, and numerous clusters of erythroid islands in the hepatic sinusoids. He was provided with a salt-restricted diet and diuretics with partial response and was scheduled for a transjugular intrahepatic portosystemic shunt.
Conclusion:
Extramedullary hematopoiesis should always be considered in patients with myeloproliferative disorders with a rare case of portal hypertension.
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22
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Ermakov IV, Kolygin AV, Gasanov MM, Yudin IV, Goncharova NN, Sazhin AV. [Spontaneous diffuse chylous peritonitis during pregnancy]. Khirurgiia (Mosk) 2019:100-105. [PMID: 31825349 DOI: 10.17116/hirurgia2019121100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Spontaneous chylous peritonitis during pregnancy is a rare disease. Only a few publications are currently devoted to this problem. The authors reported successful treatment of a patient with spontaneous chylous peritonitis in the first trimester of pregnancy. Moreover, etiology, epidemiology, pathophysiology, diagnosis and treatment of patients with spontaneous chylous peritonitis and chiloperitoneum are analyzed. The authors consider laparoscopy as a safe and efficient method of treatment of patients with spontaneous chylous peritonitis including pregnant women.
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Affiliation(s)
- I V Ermakov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Kolygin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M M Gasanov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - I V Yudin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - N N Goncharova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Sazhin
- Pirogov Russian National Research Medical University, Moscow, Russia
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23
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Koyama R, Maeda Y, Minagawa N, Shinohara T, Hamada T. Chylous Ascites Accompanying Internal Hernia after Total Gastrectomy with Roux-en-Y Reconstruction. Case Rep Gastroenterol 2019; 13:481-486. [PMID: 31824237 DOI: 10.1159/000504565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/31/2019] [Indexed: 12/23/2022] Open
Abstract
We report the case of a 69-year-old man with a history of esophagogastric junction cancer (Barrett's esophageal cancer; pT1b [SM], N0, M0, pStage IA) that was surgically resected 2 years prior to the present episode. Recurrence was not observed during follow-up. Following complaints of dysphagia and abdominal pain, computed tomography revealed signs of internal hernia. Thus, laparoscopic exploration was performed. Intraoperatively, accumulation of chylous ascites accompanying the internal hernia through the jejunojejunostomy mesenteric defect was observed, which was successfully treated with laparoscopic hernia reduction and defect closure by sutures without intestinal resection. Here, we discuss the case and report that along with previous studies, our study suggests that chylous ascites might be a reliable sign of intestinal viability for herniated intestines.
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Affiliation(s)
- Ryota Koyama
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Yoshiaki Maeda
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Nozomi Minagawa
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Toshiki Shinohara
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Tomonori Hamada
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
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24
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Ahn SH, Kim WD, Kim YJ. Successful Treatment in a Newborn Infant with Chylous Ascites and Chylous Hydrocele. NEONATAL MEDICINE 2019. [DOI: 10.5385/nm.2019.26.4.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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25
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Chamberlain SL, Ackermann T, Chan Y, Ghadiri M. White mesentery and chylous ascites: an interesting presentation of mesenteric lymphangioma. J Surg Case Rep 2019; 2019:rjz301. [PMID: 31798825 PMCID: PMC6882268 DOI: 10.1093/jscr/rjz301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 07/28/2019] [Accepted: 09/22/2019] [Indexed: 12/12/2022] Open
Abstract
We present an interesting and unusual case of a 57-year-old woman presenting with symptoms concerning for a bowel obstruction, and diagnostic imaging concerning for an internal hernia. The patient underwent an emergency laparotomy and was found to have chylous ascites throughout the abdomen, and the extravasation of chyle into the mesentery giving an appearance of a white mesentery. During this case, we will present all of the findings and discuss the unusual underlying pathology.
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Affiliation(s)
| | - Travis Ackermann
- Hepatobiliary and General Surgery, Monash Health, Clayton, VIC 3168, Australia
| | - Yuen Chan
- Pathology, Monash Health, Clayton, VIC 3168, Australia
| | - Marjan Ghadiri
- Upper GI and General Surgery, Monash Health, Clayton, VIC 3168, Australia
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26
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Kostov S, Yordanov A, Slavchev S, Strashilov S, Dzhenkov D. First Case of Chylous Ascites after Laparoscopic Myomectomy: A Case Report with a Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E624. [PMID: 31547593 PMCID: PMC6843166 DOI: 10.3390/medicina55100624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 12/12/2022]
Abstract
Introduction: Chylous ascites is a rare form of ascites characterized by milk-like peritoneal fluid, rich in triglycerides. Clinical signs and symptoms include abdominal distention, pain, nausea, and vomiting. In gynecology, the most common cause for its occurrence is lymph dissection leading to impairment of major lymphatic vessels. There are only a few reported cases of chylous ascites arising after operations for benign diseases. Case report: We report a case of a 46-year-old female patient, who underwent laparoscopy for a myomatous node with chylous ascites occurring on post-surgery Day 2. The ascites was conservatively managed. The exact cause of the chyloperitonitis could not be determined. Conclusion: Although extremely rarely, chylous ascites may also occur in operative interventions for benign diseases in gynecological surgery.
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Affiliation(s)
- Stoyan Kostov
- Department of Gynecology, Medical University Varna, 9000 Varna, Bulgaria.
| | - Angel Yordanov
- Department of Gynecologic Oncology, Medical University Pleven, 5800 Pleven, Bulgaria.
| | - Stanislav Slavchev
- Department of Gynecology, Medical University Varna, 9000 Varna, Bulgaria.
| | - Strahil Strashilov
- Department of Plastic Restorative, Reconstructive and Aesthetic Surgery, Medical University Pleven, 5800 Pleven, Bulgaria.
| | - Deyan Dzhenkov
- Department of General and Clinical pathology, Forensic Medicine and Deontology, Medical University Varna, 9002 Varna, Bulgaria.
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Chen C, Chu SY, Lin C, Liu KH, Cheng MH. Intra-abdominal chylovenous bypass treats retroperitoneal lymphangiomatosis. J Surg Oncol 2019; 121:75-84. [PMID: 31273800 DOI: 10.1002/jso.25514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Retroperitoneal lymphangiomatosis (RL) is a rare form of primary lymphedema featuring aberrant retroperitoneal lymphatic proliferation. It causes recurrent cellulitis, repeated interventions, and poor life quality. This study aimed to investigate proper diagnositc criteria and surgical outcomes for RL with extremity lymphedema. METHODS Between 2012 and 2018, 44 primary lower-extremity lymphedema cases received lymphoscintigraphy, magnetic resonance imaging, and single-photon electron computed tomography to detect RL. RL patients underwent vascularized lymph node transfers (VLNT) for extremity lymphedema and intra-abdominal side-to-end chylovenous bypasses (CVB) for chylous ascites. Complications, CVB patency, and quality of life were evaluated postoperatively. RESULTS Six RL patients (mean age of 30.3 years) had chylous ascites with five had lower-extremity lymphedema. All CVBs remained patent, though one required re-anastomosis, giving a 100% patency rate. Four unilateral and one bilateral extremity lymphedema underwent six VLNTs with 100% flap survival. Patients reported improved quality of life (P = 0.023), decreased cellulitis incidence (P = 0.041), and improved mean lymphedema circumference (P = 0.043). All patients resumed a normal diet and activity. CONCLUSIONS Evaluating primary lower-extremity lymphedema patients with MRI and SPECT could reveal a 13.6% prevalence of RL and guide treatment of refractory extremity lymphedema. Intra-abdominal CVB with VLNT effectively treated RL with chylous ascites and extremity lymphedema.
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Affiliation(s)
- Courtney Chen
- UC San Diego School of Medicine, San Diego, California
| | - Sung-Yu Chu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chieh Lin
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ken-Hao Liu
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Huei Cheng
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
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28
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Quiloperitoneo incidental asociado a hernia de Petersen en paciente operada de bypass gástrico laparoscópico. Cir Esp 2019; 97:351-353. [DOI: 10.1016/j.ciresp.2018.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/14/2018] [Accepted: 10/09/2018] [Indexed: 12/31/2022]
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29
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Brown S, Abana CO, Hammad H, Brown A, Mhlanga J, Binder C, Nabavizadeh N, Thomas C, Mitin T, Gilbert EW. Low-Dose Radiation Therapy is an Effective Treatment for Refractory Postoperative Chylous Ascites: A Case Report. Pract Radiat Oncol 2019; 9:153-157. [DOI: 10.1016/j.prro.2018.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/20/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022]
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30
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Gremida A, Atkinson C, Lopez-Portillo G, Kaza A, McCarthy D. Milking the System: Dietary Therapy of Post-nephrectomy Chylous Ascites. Dig Dis Sci 2019; 64:1133-1137. [PMID: 30949904 DOI: 10.1007/s10620-019-05611-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Anas Gremida
- Division of Gastroenterology and Hepatology, University of New Mexico School of Medicine Medical Center, MSC 10-5550, 1, Albuquerque, NM, USA.
| | - Christopher Atkinson
- Division of Gastroenterology and Hepatology, University of New Mexico School of Medicine Medical Center, MSC 10-5550, 1, Albuquerque, NM, USA
| | - Glenda Lopez-Portillo
- Department of Internal Medicine, University of New Mexico School of Medicine Medical Center, Albuquerque, NM, USA
| | - Archana Kaza
- Division of Gastroenterology and Hepatology, University of New Mexico School of Medicine Medical Center, MSC 10-5550, 1, Albuquerque, NM, USA
| | - Denis McCarthy
- Division of Gastroenterology and Hepatology, University of New Mexico School of Medicine Medical Center, MSC 10-5550, 1, Albuquerque, NM, USA
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Tsai MK, Lai CH, Chen LM, Jong GP. Calcium Channel Blocker-Related Chylous Ascites: A Systematic Review and Meta-Analysis. J Clin Med 2019; 8:jcm8040466. [PMID: 30959848 PMCID: PMC6518248 DOI: 10.3390/jcm8040466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/27/2019] [Accepted: 04/03/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chylous ascites is an uncommon condition characterized by a white, milky-appearing peritoneal fluid, and is related to disruption of the lymphatic system from any cause. There have been very few previous reports of calcium channel blockers (CCBs) as potential causes of chylous ascites, and most of the patients were undergoing peritoneal dialysis. AIMS To review the pathogenesis, clinical manifestations, laboratory examinations, treatment options, and prognosis of patients with CCB-related chylous ascites. METHOD A retrospective analysis was conducted for patients with CCB-related chylous ascites from publications in PubMed, EMBASE, and LILACS between January 1993 and December 2018. RESULTS A total of 48 cases were included. The average age at disease onset was 50.2 ± 10.9 years, with a male:female ratio of 1.5:1.0. The symptoms of abdominal distension/pain and chylous ascites were observed within 48⁻72 h of drug initiation and disappeared within 24 h of drug withdrawal. Rechallenge was performed in 10 patients, and all (100%) of them showed chylous effluents that disappeared within 24 h after stopping drug treatment. CONCLUSIONS To summarize, CCB-related chylous ascites is formed of white, milky ascites/effluents that appear after administration of CCBs. Physicians must be aware of the possibility of chylous ascites when administering CCBs, particularly in patients with renal function impairment or patients with end-stage renal disease who are undergoing peritoneal dialysis.
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Affiliation(s)
- Meng-Ko Tsai
- Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung 41168, Taiwan.
- National Defense Medical Center, Taipei 11490, Taiwan.
| | - Chao-Hung Lai
- Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung 41168, Taiwan.
| | - Li-Mien Chen
- Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung 41168, Taiwan.
| | - Gwo-Ping Jong
- Department of Internal Medicine, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung 40201, Taiwan.
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Cloudy Dialysate as the Initial Presentation for Lymphoma. Case Rep Nephrol 2018; 2018:2192043. [PMID: 30402307 PMCID: PMC6198577 DOI: 10.1155/2018/2192043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/20/2018] [Indexed: 12/23/2022] Open
Abstract
Turbid dialysate in a patient on peritoneal dialysis is usually due to peritonitis and almost all these patients are started on empirical antibiotics pending cultures. However, in few of them with culture negative fluid, this could represent other etiologies like chyle, which requires more intensive investigations, and analysis of fluid itself reveals some rare diagnosis. We present one such report of chylous ascites with prompt investigation leading to a diagnosis of malignancy in a peritoneal dialysis patient.
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Parmar K, Khanna A, Singh SK, Manoharan V. Chylous ascites following robot-assisted radical prostatectomy and extended pelvic lymph node dissection: Discussion of the aetiology and management of an unusual occurrence. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415818788501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Kalpesh Parmar
- Department of Urology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Khanna
- Department of Urology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shrawan Kumar Singh
- Department of Urology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vignesh Manoharan
- Department of Urology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Bhardwaj R, Vaziri H, Gautam A, Ballesteros E, Karimeddini D, Wu GY. Chylous Ascites: A Review of Pathogenesis, Diagnosis and Treatment. J Clin Transl Hepatol 2018; 6:105-113. [PMID: 29577037 PMCID: PMC5863006 DOI: 10.14218/jcth.2017.00035] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 09/26/2017] [Accepted: 09/30/2017] [Indexed: 12/12/2022] Open
Abstract
Chylous ascites (CA) is a rare form of ascites that results from the leakage of lipid-rich lymph into the peritoneal cavity. This usually occurs due to trauma and rupture of the lymphatics or increased peritoneal lymphatic pressure secondary to obstruction. The underlying etiologies for CA have been classified as traumatic, congenital, infectious, neoplastic, postoperative, cirrhotic or cardiogenic. Since malignancy and cirrhosis account for about two-thirds of all the cases of CA in Western countries, in this article we have attempted to reclassify CA based on portal and non-portal etiologies. The diagnosis of CA is based on the distinct characteristic of the ascitic fluid which includes a milky appearance and a triglyceride level of >200 mg/dL. The management consists of identifying and treating the underlying disease process, dietary modification, and diuretics. Some studies have also supported the use of agents such as orlistat, somatostatin, octreotide and etilefrine. Paracentesis and surgical interventions in the form of transjugular intrahepatic portosystemic shunt (commonly known as TIPS), peritoneal shunt, angiography with embolization of a leaking vessel, and laparotomy remain as treatment options for cases refractory to medical management.
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Affiliation(s)
- Richa Bhardwaj
- Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT, USA
- *Correspondence to: Richa Bhardwaj, Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT 06030, USA. Tel/Fax: +1-860-679-4613, E-mail:
| | - Haleh Vaziri
- Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT, USA
| | - Arun Gautam
- Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT, USA
| | | | - David Karimeddini
- Department of Diagnostic Imaging and Therapeutics, UCONN Health, Farmington, CT, USA
| | - George Y. Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT, USA
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Wu X, Vega M, Swartz SJ, Michael M. Milky appearance of peritoneal fluid in a neonate on peritoneal dialysis due to end-stage renal disease: Answers. Pediatr Nephrol 2018; 33:73-76. [PMID: 28283762 DOI: 10.1007/s00467-017-3633-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Xiaoyan Wu
- Renal Section, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, 1102 Bates Avenue, Suite 245, Houston, TX, 77030, USA
| | - Molly Vega
- Renal Section, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, 1102 Bates Avenue, Suite 245, Houston, TX, 77030, USA
| | - Sarah J Swartz
- Renal Section, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, 1102 Bates Avenue, Suite 245, Houston, TX, 77030, USA
| | - Mini Michael
- Renal Section, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, 1102 Bates Avenue, Suite 245, Houston, TX, 77030, USA.
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Lizaola B, Bonder A, Trivedi HD, Tapper EB, Cardenas A. Review article: the diagnostic approach and current management of chylous ascites. Aliment Pharmacol Ther 2017; 46:816-824. [PMID: 28892178 DOI: 10.1111/apt.14284] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 07/15/2017] [Accepted: 08/11/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Chylous ascites is rare, accounting for less than 1% of cases. An appropriate and stepwise approach to its diagnosis and management is of key importance. AIM To review the current diagnostic approach and management of chylous ascites. METHODS A literature search was conducted using PubMed using the key words 'chylous', 'ascites', 'cirrhosis', 'pathophysiology', 'nutritional therapy', 'paracentesis", "transjugular intrahepatic portosystemic shunt" and "TIPSS'. Only articles in English were included. RESULTS Chylous ascites is caused by the traumatic or obstructive disruption of the lymphatic system that leads to extravasation of thoracic or intestinal lymph into the abdominal space and the accumulation of a milky fluid rich in triglycerides. The most common causes are malignancy, cirrhosis and trauma after abdominal surgery. This condition can lead to chyle depletion, which results in nutritional, immunologic and metabolic deficiencies. An ascitic triglyceride concentration above 200 mg/dL is consistent with chylous ascites. Treatment is based on management of the underlying cause and nutritional support. CONCLUSIONS Chylous ascites is mostly due to malignancy and cirrhosis in adults, and congenital lymphatic disorders in children. Treatment with nutritional optimization and management of the underlying etiology are the cornerstones of therapy. When conservative measures fail, other interventions such as octreotide/somatostatin analogues, surgical ligation, embolization and transjugular intrahepatic portosystemic shunt in patients with cirrhosis can be considered.
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Affiliation(s)
- B Lizaola
- Department of Medicine, St. Elizabeth Medical Center, Brighton, MA, USA
| | - A Bonder
- Liver Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - H D Trivedi
- Liver Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - E B Tapper
- Department of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - A Cardenas
- GI/Liver Unit, Institute of Digestive Diseases and Metabolism, University of Barcelona, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona, Spain
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Daniel A, Bagnato G, Vital E, Del Galdo F. Chylous ascites in a patient with an overlap syndrome: a surprising response to rituximab. BMJ Case Rep 2017; 2017:bcr-2017-222339. [PMID: 29054902 DOI: 10.1136/bcr-2017-222339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The authors present a case of a 51-year-old woman with clinical diagnosis of mixed connective tissue disease and overlap systemic lupus erythematosus features, with a 6-month history of progressive painless abdominal distension. On examination, evident signs of ascites were present. Both the abdominal-pelvic ultrasound and CT scan confirmed a large amount of ascites. A diagnostic paracentesis was performed, which revealed typical features of chylous ascites (CA). An extensive diagnostic work-up led by a multidisciplinary team was performed, excluding malignancy, cirrhosis, infectious, as well as cardiac and primary lymphatic causes. The patient was kept under surveillance, with dietary therapy and periodic ascitic drainages. The hypothesis of an autoimmune cause for CA was considered by exclusion. Rituximab therapy was initiated and an excellent response was achieved, with reduction of the rate of accumulation of CA and an increase in quality of life of the patient.
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Affiliation(s)
- Alexandra Daniel
- Department of Rheumatology Unit, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Gianluca Bagnato
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Edward Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Francesco Del Galdo
- Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Huang Y, Gloviczki P, Duncan AA, Fleming MD, Driscoll DJ, Kalra M, Oderich GS, Bower TC. Management of refractory chylous ascites with peritoneovenous shunts. J Vasc Surg Venous Lymphat Disord 2017. [PMID: 28623993 DOI: 10.1016/j.jvsv.2017.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Srinivasan A, Apostolov R, Leong A, Johnson D. Atraumatic chylous ascites: an unusual presentation of bladder cancer. BMJ Case Rep 2017; 2017:bcr-2016-219006. [PMID: 28473429 DOI: 10.1136/bcr-2016-219006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a case of bladder cancer presenting with atraumatic chylous ascites, which remains an extremely rare presentation of this condition. A previously well, elderly ex-smoker with no prior history of abdominal surgery was referred for investigation of progressive dyspnoea, increasing peripheral oedema and new-onset ascites, on a background of long-standing alcohol consumption (four standard drinks daily). Liver biochemistry and coagulation profile were normal apart from marked hypoalbuminaemia. Doppler ultrasound of the liver demonstrated normal echotexture and patent vasculature. Abdominal paracentesis yielded 8 L of milk-coloured, triglyceride-rich fluid with abundant malignant cells. Urine cytology demonstrated malignant transitional cells, with radiological evidence of a large enhancing bladder mass, with evidence of adjacent lymphadenopathy and omental involvement. A diagnosis of metastatic stage IV transitional cell bladder cancer was made. The patient declined palliative chemotherapy and passed away 2 months after their initial presentation.
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Affiliation(s)
| | - Ross Apostolov
- Department of Gastroenterology, Austin Health, Melbourne, Australia
| | - Amanda Leong
- Department of Gastroenterology, Austin Health, Melbourne, Australia
| | - Douglas Johnson
- Department of General Medicine, Austin Health, Heidelberg, Australia
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Kassem R, Rajab A, Faiz A, Kumar SY, John SA, Taher O. Chylous ascites in an infant – Treated surgically with fibrin glue after failed medical treatment - A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
We report the first observation of a patient with contgenital chylous ascites (CCA) and Ehlers-Danlos syndrome type VI due to primary lymphatic defect with additional vascular anomaly. CCA is a rare condition, and there is limited understanding of its pathophysiology and treatment options. We also review the patient’s treatment course mitigated with octreotide and total parenteral nutritional support, as there are no current established guidelines for CCA. Early recognition of possible association with Ehlers-Danlos syndrome is important for quick intervention and successful management of pediatric patients.
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Ultrasound-Guided Intranodal Lymphangiography With Ethiodized Oil to Treat Chylous Ascites. ACG Case Rep J 2016; 3:e95. [PMID: 27807557 PMCID: PMC5062668 DOI: 10.14309/crj.2016.68] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/29/2016] [Indexed: 12/23/2022] Open
Abstract
A 70-year-old man presented with abdominal distention and pain. A diagnosis of chylous ascites (CA) was made by abdominal paracentesis. Conservative treatment had failed to control CA; therefore, ultrasound-guided intranodal lymphangiography (UIL) with Lipiodol was performed. No obvious Lipiodol leakage was observed in the follow-up computed tomography; however, the persistent abdominal pain was significantly reduced within a day, and CA was resolved within 3 days. We present successful treatment of CA using UIL with Lipiodol. The combination of the technique of UIL and therapeutic lymphangiography with Lipiodol is a promising minimally invasive treatment option for CA.
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McNeal PM, Bush JS, Reeves CF, Connors NJ. Man With Abdominal Swelling. Ann Emerg Med 2016; 68:163-95. [PMID: 27451299 DOI: 10.1016/j.annemergmed.2016.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Indexed: 10/21/2022]
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Akama Y, Shimizu T, Fujita I, Kanazawa Y, Kakinuma D, Kanno H, Yamagishi A, Arai H, Uchida E. Chylous ascites associated with intestinal obstruction from volvulus due to Petersen's hernia: report of a case. Surg Case Rep 2016; 2:77. [PMID: 27468960 PMCID: PMC4965361 DOI: 10.1186/s40792-016-0207-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/23/2016] [Indexed: 12/23/2022] Open
Abstract
Background Chylous ascites is an uncommon finding which is usually associated with recent abdominal/oncologic or retroperitoneal surgery. It is not usually seen in cases of acute obstruction. Case presentation A patient who had previously undergone a laparoscopy-assisted distal gastrectomy with Roux-en-Y reconstruction for early gastric cancer presented with acute abdominal pain and epigastric fullness. Computed tomography suggested small bowel obstruction due to volvulus. We were able to reduce the volvulus and close a Petersen’s hernia without resecting the bowel; a large amount of chylous ascites was an incidental finding. Conclusions We present a case of chylous ascites occurring in a setting of small bowel obstruction due to Petersen’s hernia, 3 years after successful distal gastrectomy for early gastric cancer, with no evidence of tumor recurrence.
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Affiliation(s)
- Yuichi Akama
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan.
| | - Tetsuya Shimizu
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan
| | - Itsuo Fujita
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan
| | - Yoshikazu Kanazawa
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan
| | - Daisuke Kakinuma
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan
| | - Hitoshi Kanno
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan
| | - Aya Yamagishi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan
| | - Hiroki Arai
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan
| | - Eiji Uchida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan
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Romics M, Tasnadi G, Sulya B, Kiss A, Merksz M, Nyirady P. Congenital lymphovascular malformations with urological symptoms: a report of two cases and review of the literature. Int Urol Nephrol 2016; 48:1771-1775. [DOI: 10.1007/s11255-016-1365-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/30/2016] [Indexed: 01/30/2023]
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Abstract
Ascites is the pathologic accumulation of fluid within the peritoneal cavity. There are many causes of fetal, neonatal and pediatric ascites; however, chronic liver disease and subsequent cirrhosis remain the most common. The medical and surgical management of ascites in children is dependent on targeting the underlying etiology. Broad categories of management strategies include: sodium restriction, diuresis, paracentesis, intravenous albumin, prevention and treatment of infection, surgical and endovascular shunts and liver transplantation. This review updates and expands the discussion of the unique considerations regarding the management of cirrhotic and non-cirrhotic ascites in the pediatric patient.
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Affiliation(s)
- Erin R Lane
- a 1 Pediatric Gastroenterology, University of Washington School of Medicine, 4800 Sand Point Way, NE, PO Box 5371/OB.9.640, Seattle, WA 98105, USA
| | - Evelyn K Hsu
- b 2 Division of Gastroenterology and Hepatology Seattle Children's and the University of Washington, PO Box 5371/OB.9.640, Seattle, WA 98155, USA
| | - Karen F Murray
- b 2 Division of Gastroenterology and Hepatology Seattle Children's and the University of Washington, PO Box 5371/OB.9.640, Seattle, WA 98155, USA
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Joshi B, Mavuduru RS, Mandal AK, Bhattacharya A, Lal A, Jain V. Chylocolporrhea or chylous vaginal discharge: diagnostic conundrum with therapeutic challenge. Arch Gynecol Obstet 2015; 293:815-8. [PMID: 26386963 DOI: 10.1007/s00404-015-3882-z] [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: 05/29/2015] [Accepted: 09/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chylocolporrhea or chylous vaginal discharge is an extremely rare manifestation of chylous reflux syndrome. Continuous loss of chyle adversely affects quality of life and results in increased morbidity due to the chronic loss of nutrients. Diagnosis and management of this condition is very challenging. CASE HISTORY A 35-year-old multiparous lady presented with the chief complaints of excessive milky vaginal discharge for 10 years. Microscopic and biochemical analysis of vaginal discharge along with hysteroscopy confirmed diagnosis of chylocolporrhea. Lymphoscintigraphy along with magnetic resonance imaging revealed site of leakage from the right external iliac lymphatics. She was started on medium-chain triglycerides-rich diet and meticulous ligation of all visible megalymphatics with tension-free lymphovenous anastomosis was done to right external iliac vein. CONCLUSION Chylocolporrhea can be managed successfully using operative and nonoperative modalities.
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Affiliation(s)
- Bharti Joshi
- Department of Obstetrics and Gynecology, Institute of Medical Education and Research, Chandigarh, India.
| | - R S Mavuduru
- Department of Urology, Institute of Medical Education and Research, Chandigarh, India
| | - A K Mandal
- Department of Urology, Institute of Medical Education and Research, Chandigarh, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine, Institute of Medical Education and Research, Chandigarh, India
| | - Anupam Lal
- Department of Radiology, Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Jain
- Department of Obstetrics and Gynecology, Institute of Medical Education and Research, Chandigarh, India
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49
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Chylous Ascites: A Rare Adverse Effect of Methimazole Treatment for Grave's Disease-A Case Report and Review of the Literature. Case Rep Endocrinol 2015; 2015:649303. [PMID: 26366308 PMCID: PMC4561093 DOI: 10.1155/2015/649303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/12/2015] [Indexed: 02/07/2023] Open
Abstract
A 40-year-old woman was admitted due to an urticarial rash that was attributed to recent onset of methimazole treatment for a diagnosis of Grave's disease. The patient had no prior significant medical history and used no medications, including over-the-counter or herbal medications. Her sister had Grave's disease. On admission, the patient received corticosteroids with improvement in her rash. On the second day of the hospitalization, the patient complained of abdominal discomfort. Abdominal ultrasound revealed a large amount of new onset ascites. Peritoneal tap yielded a milky fluid with high triglyceride level (12.2 mmol/L or 1080 mg/dL), consistent with chylous ascites. After discontinuation of the methimazole, the ascites disappeared. The patient later underwent therapeutic thyroidectomy, after which all features of thyrotoxicosis had improved.
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Mihara M, Hara H, Shibasaki J, Seki Y, Hayashi A, Iida T, Adachi S, Uchida Y, Kaneko H, Haragi M, Murakami A. Indocyanine Green Lymphography and Lymphaticovenous Anastomosis for Generalized Lymphatic Dysplasia with Pleural Effusion and Ascites in Neonates. Ann Vasc Surg 2015; 29:1111-22. [DOI: 10.1016/j.avsg.2015.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 02/07/2015] [Accepted: 02/22/2015] [Indexed: 12/23/2022]
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