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Padari H, Kipper K, Eelmäe I, Nerman J, Lintrop M, Metsvaht T. Sudan black poisoning resulted in methemoglobinemia in a baby with congenital chyloperitoneum. Clin Case Rep 2024; 12:e8676. [PMID: 38585587 PMCID: PMC10995245 DOI: 10.1002/ccr3.8676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/11/2024] [Accepted: 03/01/2024] [Indexed: 04/09/2024] Open
Abstract
Treatment of congenital chyloperitoneum is a challenge. Conservative methods may be ineffective. Preoperative visualization of the site of lymphatic leakage is crucial, but radiological imaging is technically complicated and may not provide sufficient information, especially in small patients. To ease the detection of lymphatic leakage during surgery, preoperative feeding with fat-rich formula with Sudan Black has been recommended. However, administration of Sudan Black may result in life-threatening methemoglobinemia and liver damage without any advantage of revealing leakage during surgery. We recommend preoperative feeding with pure fat-rich formula.
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Zahradnikova P, Pechanova R, Fedorova L, Jager R, Nedomova B, Babala J. Laparoscopic management of the congenital chylous ascites in a newborn: Case report. J Minim Access Surg 2023; 19:548-551. [PMID: 37282439 PMCID: PMC10695317 DOI: 10.4103/jmas.jmas_304_22] [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: 11/01/2022] [Revised: 01/06/2023] [Accepted: 01/27/2023] [Indexed: 06/08/2023] Open
Abstract
Congenital chylous ascites (CCA) is a rare condition seen in the neonatal period. The pathogenesis is primarily related to congenital intestinal lymphangiectasis. Conservative treatment of chylous ascites involves paracentesis, total parenteral nutrition (TPN), medium-chain triglyceride (MCT)-based milk formula, use of somatostatin analogue and octreotide. Surgical treatment is considered when conservative treatment fails. We describe a laparoscopic treatment of CCA using the fibrin glue technique. A male infant, in whom foetal ascites was detected at 19 weeks of gestation, was born by caesarean section at 35 weeks of gestation weighing 3760 g. There was evidence of hydrops in the foetal scan. A diagnosis of chylous ascites was made by abdominal paracentesis. A magnetic resonance scan was suggestive of gross ascites, and no lymphatic malformation was identified. TPN and octreotide infusion was started and continued for 4 weeks, but the ascites persisted. The failure of conservative treatment led us to perform laparoscopic exploration. Intraoperatively, chylous ascites and multiple prominent lymphatic vessels around the root of the mesentery were noted. The fibrin glue was applied over the leaking mesenteric lymphatic vessels in the duodenopancreatic region. Oral feeding was started from post-operative day 7. After 2 weeks of the MCT formula, ascites progressed. Thus, laparoscopic exploration was necessary. We introduced an endoscopic applicator for fibrin glue and applied it into the place of leakage. The patient was doing well with no appearance of ascites reaccumulating and was discharged on the 45th post-operative day. Follow-up ultrasonography (1st, 3rd and 9th months after discharge) showed a small amount of ascitic fluid but with no clinical significance. Laparoscopic localisation and ligation of leakage sites could be difficult, especially in newborns and young infants due to the small size of lymphatic vessels. The use of fibrin glue to seal the lymphatic vessels is quite promising.
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Affiliation(s)
- Petra Zahradnikova
- Department of Paediatric Surgery, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
| | - Rebeka Pechanova
- Department of Paediatric Surgery, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
| | - Lenka Fedorova
- Department of Paediatric Surgery, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
| | - Rene Jager
- Department of Paediatric Surgery, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
| | - Barbora Nedomova
- Department of Paediatric Anaesthesiology and Intensive Medicine, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
| | - Jozef Babala
- Department of Paediatric Surgery, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
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3
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Nakano TA, Dori Y, Gumer L, Liptzin DR, Hill LRS, Kulungowski AM. How we approach pediatric congenital chylous effusions and ascites. Pediatr Blood Cancer 2022; 69 Suppl 3:e29246. [PMID: 36070215 DOI: 10.1002/pbc.29246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/19/2021] [Accepted: 06/27/2021] [Indexed: 11/10/2022]
Abstract
Congenital lymphatic leak may develop in patients with maldeveloped lymphatics and result in life-threatening fluid and electrolyte imbalance, protein deficiency, and immunodeficiency. Rapid diagnosis and therapy are necessary to prevent these complications; however, the field lacks clinical trials to support standardized diagnostic treatment guidelines. We present our current multidisciplinary approach to the diagnosis and management of congenital lymphatic leak including chylous pleural effusions and ascites. Depending on the rate of lymphatic leak, therapy can range from observation with nutritional modifications to surgical and interventional procedures aimed to reduce lymphatic drainage. Modalities to image central and peripheral lymphatics have advanced considerably. Genetic variants and subsequent targets that drive lymphatic maldevelopment have expanded the repertoire of possible pharmacotherapeutic options.
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Affiliation(s)
- Taizo A Nakano
- Vascular Anomalies Center, Children's Hospital Colorado, Aurora, Colorado, USA.,Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Yoav Dori
- Division of Cariology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lindsey Gumer
- Division of Pediatric Gastroenterology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Deborah R Liptzin
- Breathing Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lauren R S Hill
- Vascular Anomalies Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Ann M Kulungowski
- Vascular Anomalies Center, Children's Hospital Colorado, Aurora, Colorado, USA.,Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
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4
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Ojha S, Bharadia L, Chaturvedi A. Refractory congenital chylous ascites: First report of fibrin glue and mesh application by laparoscopy. J Minim Access Surg 2022; 18:469-471. [PMID: 35708391 PMCID: PMC9306116 DOI: 10.4103/jmas.jmas_228_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Chylous ascites (CA) is a form of ascites having leakage of lipid-rich lymph into the peritoneal cavity, due to damage or obstruction in the lymphatic system. Aetiology of CA could be congenital or acquired. Primary lymphatic hypoplasia is seen commonly in children and presents with lymphoedema, chylothorax or CA. CA is initially treated conservatively with the aim to provide gut rest and decrease intestinal secretions. Surgical treatment is recommended if 1–2 months of conservative approach fails. The success of the operation depends on identifying the site of leakage of the lymphatic duct. Surgical options are ligation of leaking lymphatics, peritoneo-venous shunt, laparotomy and fibrin glue. Laparoscopy has been used for diagnosis but not for glue and mesh application in congenital CA where the lymphatic leak is unidentified. We present here the first experience of laparoscopic fibrin glue and mesh application in congenital CA with successful outcomes.
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5
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Mimura H, Akita S, Fujino A, Jinnin M, Ozaki M, Osuga K, Nakaoka H, Morii E, Kuramochi A, Aoki Y, Arai Y, Aramaki N, Inoue M, Iwashina Y, Iwanaka T, Ueno S, Umezawa A, Ozeki M, Ochi J, Kinoshita Y, Kurita M, Seike S, Takakura N, Takahashi M, Tachibana T, Chuman K, Nagata S, Narushima M, Niimi Y, Nosaka S, Nozaki T, Hashimoto K, Hayashi A, Hirakawa S, Fujikawa A, Hori Y, Matsuoka K, Mori H, Yamamoto Y, Yuzuriha S, Rikihisa N, Watanabe S, Watanabe S, Kuroda T, Sugawara S, Ishikawa K, Sasaki S. Japanese clinical practice guidelines for vascular anomalies 2017. Jpn J Radiol 2020; 38:287-342. [PMID: 32207066 PMCID: PMC7150662 DOI: 10.1007/s11604-019-00885-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine (EBM) techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of September 2014 was searched in Pubmed, Cochrane Library, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System (MINDS) technique. A total of 33 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
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Affiliation(s)
- Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Sadanori Akita
- Department of Plastic Surgery, Wound Repair and Regeneration, Fukuoka University, School of Medicine, Fukuoka, Japan
| | - Akihiro Fujino
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Mine Ozaki
- Department of Plastic and Reconstructive, Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroki Nakaoka
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Kuramochi
- Department of Dermatology, Saitama Medical University, Irumagun, Japan
| | - Yoko Aoki
- Department of Medical Genetics, Tohoku University School of Medicine, Sendai, Japan
| | - Yasunori Arai
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Noriko Aramaki
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Iwashina
- Department of Plastic and Reconstructive, Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shigeru Ueno
- Department of Pediatric Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Akihiro Umezawa
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Junko Ochi
- Department of Diagnostic Radiology, Tohoku University, Sendai, Japan
| | - Yoshiaki Kinoshita
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masakazu Kurita
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shien Seike
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuyuki Takakura
- Department of Signal Transduction, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Masataka Takahashi
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Kumiko Chuman
- Department of Dermatology, Kanto Central Hospital, Tokyo, Japan
| | - Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke’s International Hospital, Tokyo, Japan
| | - Shunsuke Nosaka
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, St Luke’s International Hospital, Tokyo, Japan
| | - Kazuki Hashimoto
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Satoshi Hirakawa
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsuko Fujikawa
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kentaro Matsuoka
- Department of Pathology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Japan
| | - Hideki Mori
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoaki Rikihisa
- Department of Plastic and Reconstructive Surgery, Oyumino Central Hospital, Chiba, Japan
| | - Shoji Watanabe
- Department of Plastic and Reconstructive Surgery, Saitama Children’s Medical Center, Saitama, Japan
| | - Shinichi Watanabe
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoru Sasaki
- Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital, Sapporo, Japan
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6
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Mimura H, Akita S, Fujino A, Jinnin M, Ozaki M, Osuga K, Nakaoka H, Morii E, Kuramochi A, Aoki Y, Arai Y, Aramaki N, Inoue M, Iwashina Y, Iwanaka T, Ueno S, Umezawa A, Ozeki M, Ochi J, Kinoshita Y, Kurita M, Seike S, Takakura N, Takahashi M, Tachibana T, Chuman K, Nagata S, Narushima M, Niimi Y, Nosaka S, Nozaki T, Hashimoto K, Hayashi A, Hirakawa S, Fujikawa A, Hori Y, Matsuoka K, Mori H, Yamamoto Y, Yuzuriha S, Rikihisa N, Watanabe S, Watanabe S, Kuroda T, Sugawara S, Ishikawa K, Sasaki S. Japanese Clinical Practice Guidelines for Vascular Anomalies 2017. J Dermatol 2020; 47:e138-e183. [PMID: 32200557 PMCID: PMC7317503 DOI: 10.1111/1346-8138.15189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 01/19/2023]
Abstract
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety and systematizing treatment, employing evidence‐based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQ) were decided based on the important clinical issues. For document retrieval, key words for published work searches were set for each CQ, and work published from 1980 to the end of September 2014 was searched in PubMed, Cochrane Library and Japana Centra Revuo Medicina databases. The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System technique. A total of 33 CQ were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence‐based guidelines for the management of vascular anomalies.
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Affiliation(s)
- Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Sadanori Akita
- Department of Plastic Surgery, Wound Repair and Regeneration, Fukuoka University, School of Medicine, Fukuoka, Japan
| | - Akihiro Fujino
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Mine Ozaki
- Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroki Nakaoka
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Kuramochi
- Department of Dermatology, Saitama Medical University, Iruma-gun, Japan
| | - Yoko Aoki
- Department of Medical Genetics, Tohoku University School of Medicine, Sendai, Japan
| | - Yasunori Arai
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Noriko Aramaki
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Iwashina
- Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shigeru Ueno
- Department of Pediatric Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Akihiro Umezawa
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Junko Ochi
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiaki Kinoshita
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masakazu Kurita
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shien Seike
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuyuki Takakura
- Department of Signal Transduction, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Masataka Takahashi
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Kumiko Chuman
- Department of Dermatology, Kanto Central Hospital, Tokyo, Japan
| | - Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
| | - Shunsuke Nosaka
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Kazuki Hashimoto
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Satoshi Hirakawa
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsuko Fujikawa
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kentaro Matsuoka
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hideki Mori
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoaki Rikihisa
- Department of Plastic and Reconstructive Surgery, Oyumino Central Hospital, Chiba, Japan
| | - Shoji Watanabe
- Department of Plastic and Reconstructive Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Shinichi Watanabe
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoru Sasaki
- Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital, Sapporo, Japan
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7
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Mimura H, Akita S, Fujino A, Jinnin M, Ozaki M, Osuga K, Nakaoka H, Morii E, Kuramochi A, Aoki Y, Arai Y, Aramaki N, Inoue M, Iwashina Y, Iwanaka T, Ueno S, Umezawa A, Ozeki M, Ochi J, Kinoshita Y, Kurita M, Seike S, Takakura N, Takahashi M, Tachibana T, Chuman K, Nagata S, Narushima M, Niimi Y, Nosaka S, Nozaki T, Hashimoto K, Hayashi A, Hirakawa S, Fujikawa A, Hori Y, Matsuoka K, Mori H, Yamamoto Y, Yuzuriha S, Rikihisa N, Watanabe S, Watanabe S, Kuroda T, Sugawara S, Ishikawa K, Sasaki S. Japanese clinical practice guidelines for vascular anomalies 2017. Pediatr Int 2020; 62:257-304. [PMID: 32202048 PMCID: PMC7232443 DOI: 10.1111/ped.14077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 01/19/2023]
Abstract
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine (EBM) techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of September 2014 was searched in Pubmed, Cochrane Library, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System (MINDS) technique. A total of 33 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
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Affiliation(s)
- Hidefumi Mimura
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Sadanori Akita
- Department of Plastic Surgery, Wound Repair and Regeneration, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Akihiro Fujino
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Mine Ozaki
- Department of Plastic and Reconstructive, Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroki Nakaoka
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Kuramochi
- Department of Dermatology, Saitama Medical University, Irumagun, Japan
| | - Yoko Aoki
- Department of Medical Genetics, Tohoku University School of Medicine, Sendai, Japan
| | - Yasunori Arai
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Noriko Aramaki
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Iwashina
- Department of Plastic and Reconstructive, Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shigeru Ueno
- Department of Pediatric Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Akihiro Umezawa
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Junko Ochi
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiaki Kinoshita
- Department of Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masakazu Kurita
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shien Seike
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuyuki Takakura
- Department of Signal Transduction, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Masataka Takahashi
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Kumiko Chuman
- Department of Dermatology, Kanto Central Hospital, Tokyo, Japan
| | - Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St Luke's International Hospital, Tokyo, Japan
| | - Shunsuke Nosaka
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, St Luke's International Hospital, Tokyo, Japan
| | - Kazuki Hashimoto
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Satoshi Hirakawa
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsuko Fujikawa
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kentaro Matsuoka
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hideki Mori
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoaki Rikihisa
- Department of Plastic and Reconstructive Surgery, Oyumino Central Hospital, Chiba, Japan
| | - Shoji Watanabe
- Department of Plastic and Reconstructive Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Shinichi Watanabe
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoru Sasaki
- Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital, Sapporo, Japan
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A systematic review of chyle leaks and their management following axillary surgery. Eur J Surg Oncol 2020; 46:931-942. [PMID: 32033823 DOI: 10.1016/j.ejso.2020.01.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/08/2020] [Accepted: 01/24/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Chyle leaks following surgery to the axilla are seldom encountered with an incidence <0.7%. Management varies with no consensus in the literature. Injury to branching tributaries of the thoracic duct may require lengthy management at significant cost to patient and clinical team. This paper aims to provide an up-to-date review to support clinical management. METHODS The term 'chyle' was combined with 'breast' or 'axilla.' EMBASE, Medline and PubMed database searches were conducted. All papers published in English were included with no exclusion date limits. RESULTS 51 cases from 31 papers. All were female (mean age = 53.3yrs). 47/51 leaks were left-sided. 5/51 underwent sentinel node biopsy, 19/51 level II axillary node clearance (ANC), 23/51 level III ANC, 5/51 not specified. 59% (30/51) of leaks were identified within 2 postoperative days (mean = 3.3days). 96% initially managed conservatively: Drain = 38/51; low-fat diet = 34/51; compression bandaging = 20/51; Aspiration = 6/51. 40/51 (78%) were successfully managed conservatively, 11 patients returned to theater for secondary management. 7/11 recorded volumes >500mls/24 hrs before secondary surgery. Mean resolution time from initial surgery was 17.3days (range = 4-64days). No statistically significant difference (p = 0.72) in time to resolution between conservatively and surgically managed patients. CONCLUSIONS Chyle leaks are rarely seen following axillary surgery. Aberrant thoracic duct anatomy represents the likeliest aetiology. We advocate early recognition and tailored individual management. Conservative management with non-suction drainage, low-fat diet and axillary compression bandaging appear effective where output <500ml/24 hrs. Secondary surgical management should be considered in high chylous output (<500mls/24 hrs) patients unresponsive to conservative measures. We propose a management algorithm to aide clinicians.
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Carr BD, Grant CN, Overman RE, Gadepalli SK, Geiger JD. Retroperitoneal exploration with Vicryl mesh and fibrin tissue sealant for refractory chylous ascites. J Pediatr Surg 2019; 54:604-607. [PMID: 30340876 DOI: 10.1016/j.jpedsurg.2018.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/18/2018] [Accepted: 09/25/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Congenital chylous ascites poses a significant challenge in neonatal care, and often results in prolonged, complex hospital stays and increased mortality. Few effective options exist in refractory cases. METHODS Patients aged 0 to 12 months with refractory chylous ascites underwent retroperitoneal exploration after medical treatment and minimally invasive therapies were unsuccessful. The retroperitoneum was completely exposed via left and right medial visceral rotation and opening the lesser sac. Visible leaks were ligated, and alternating layers of fibrin glue and Vicryl mesh were used to cover the entire retroperitoneum. RESULTS All 4 patients had resolution of their chylous ascites. None required reoperation or reintervention for chyle leaks. All achieved goal enteral feeds at a median of 29 days postoperatively and were discharged from hospital at a median of 42 days postoperatively. CONCLUSIONS Management of chylous ascites is extremely challenging in refractory cases. Complete retroperitoneal exposure with fibrin glue and Vicryl mesh application offers a definitive, reliable therapy for achieving cessation of lymphatic leakage and ultimate recovery for patients who fail all nonoperative approaches. STUDY TYPE Therapeutic. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Benjamin D Carr
- Department of Surgery, Division of Pediatric Surgery, University of Michigan, 1540 E Hospital Dr. SPC 4217, Ann Arbor, MI 48109, United States.
| | - Christa N Grant
- Department of Surgery, Division of Pediatric Surgery, University of Michigan, 1540 E Hospital Dr. SPC 4217, Ann Arbor, MI 48109, United States.
| | - Richard E Overman
- Department of Surgery, Division of Pediatric Surgery, University of Michigan, 1540 E Hospital Dr. SPC 4217, Ann Arbor, MI 48109, United States.
| | - Samir K Gadepalli
- Department of Surgery, Division of Pediatric Surgery, University of Michigan, 1540 E Hospital Dr. SPC 4217, Ann Arbor, MI 48109, United States.
| | - James D Geiger
- Department of Surgery, Division of Pediatric Surgery, University of Michigan, 1540 E Hospital Dr. SPC 4217, Ann Arbor, MI 48109, United States.
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Xu S, Zhang Q, Liu T, Zhang Y, Sun N. A female infant with phacomatosis pigmentovascularis and congenital chylous ascites: A case report. Medicine (Baltimore) 2018; 97:e12012. [PMID: 30142845 PMCID: PMC6112933 DOI: 10.1097/md.0000000000012012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RATIONALE Phacomatosis pigmentovascularis (PPV) is a rare syndrome characterized by capillary malformation and pigmentary nevus. Congenital chylous ascites (CCA) is also a rare disease that results from maldevelopment of the lymphatic system. We report a case of a 5-month-old girl, who had both PPV and CCA. PATIENT CONCERNS A 5-month-old girl is reported, who presented extensive nevus flammeus and an aberrant Mongolian spot with congenital chylous ascites. DIAGNOSES The expression of extensive nevus flammeus and an aberrant Mongolian spot with congenital chylous ascites, that was diagnosed as type IIb phacomatosis pigmentovascularis. INTERVENTIONS Conservative treatment included administration of somatostatin, MCT-based diet or TPN with drainage of ascitic fluid. Surgery was taken into account after failed conservative treatments. Before surgery, it is necessary to locate the abnormal lymphatic vessels. OUTCOMES Conservative treatment and surgery sometimes functioned limitedly on CCA. LESSONS According to the classification system of ISSVA (the International Society for the Study of Vascular Anomalies), this case meet the classification of CLM included in combined vascular malformations. It is likely to there is a connection between these two congenital diseases.
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Affiliation(s)
- Shuai Xu
- Department of Urology Surgery, Beijing Children's Hospital, National Center for Children's Health
| | - Qinming Zhang
- Department of Pediatric Surgery, Beijing United Hospital & Clinic
| | - Tingting Liu
- Department of Emergency Surgery, Beijing Children's Hospital, National Center for Children's Health, Beijing, China
| | - Ye Zhang
- Department of Urology Surgery, Beijing Children's Hospital, National Center for Children's Health
| | - Ning Sun
- Department of Urology Surgery, Beijing Children's Hospital, National Center for Children's Health
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Liu J, Zhang H, Du Q, Yao S. Successful Laparoscopic Treatment of Chylous Ascites after Pelvic Lymphadenectomy: A Case Report and Peanut Oil Application. J Minim Invasive Gynecol 2018; 25:923-926. [DOI: 10.1016/j.jmig.2017.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/24/2017] [Accepted: 12/28/2017] [Indexed: 01/03/2023]
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Shimajiri H, Egi H, Yamamoto M, Kochi M, Mukai S, Ohdan H. Laparoscopic management of refractory chylous ascites using fluorescence navigation with indocyanine green: A case report. Int J Surg Case Rep 2018; 49:149-152. [PMID: 30007263 PMCID: PMC6068077 DOI: 10.1016/j.ijscr.2018.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/14/2018] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Postoperative chylous ascites is a rare complication of colorectal surgery. Conservative management is usually effective in most cases of the postoperative chylous ascites. However, surgical intervention is performed for refractory cases. PRESENTATION OF CASE A 31-year-old man with neuroendocrine carcinoma developed chylous ascites after laparoscopic descending colectomy with D3 lymphadenectomy. Conservative treatment including total parenteral nutrition and somatostatin analogue failed and surgical intervention via laparoscopy was performed for the refractory chylous ascites. Lymphatic leakage was detected at the upper part of the inferior mesenteric artery during the laparoscopic exploration and was reconfirmed by intraoperative indocyanine green injection with an infrared camera system. Moreover, we injected the ICG into the other sites of the lymphadenectomy performed and identified the lymphatic flow. We confirmed there was no other lymphatic leakage. The lesion was ligated and closed with fibrin glue. Five months after the surgical intervention, no symptom was noted. DISCUSSION It is frequently difficult to detect the site of lymphatic leakage intraoperatively. Intraoperative indocyanine green injection is useful for detecting a lymphatic leakage site and especially making sure without other leakages. Additionally, laparoscopic surgery seems safe and effective for refractory chylous ascites. CONCLUSION we reported successful laparoscopic management of refractory chylous ascites using fluorescence navigation with indocyanine green.
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Affiliation(s)
- Hiroto Shimajiri
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8551, Japan.
| | - Hiroyuki Egi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8551, Japan.
| | - Masateru Yamamoto
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8551, Japan.
| | - Masatoshi Kochi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8551, Japan.
| | - Shoichiro Mukai
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8551, Japan.
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8551, Japan.
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14
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Xu S, Zhang Q, Liu T, Zhang Y, Sun N. WITHDRAWN: Phacomatosis pigmentovascularis associated with congenital chylous ascites. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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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: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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16
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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: 1.6] [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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Mesenteric lymphatic ligation in the prevention of chylous fistulae in abdominal neuroblastoma surgery. Pediatr Surg Int 2014; 30:1009-12. [PMID: 25098440 DOI: 10.1007/s00383-014-3581-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE We evaluated the effectiveness of prophylactic mesenteric lymphatic ligation in preventing iatrogenic chylous fistulae in abdominal neuroblastoma surgery. METHOD All patients who underwent resection of abdominal neuroblastoma between years 2002 and 2013 were included. A change in surgical strategy commenced from August 2010 when routine meticulous mesenteric lymphatic ligation (MLL) before abdominal closure was included in the primary surgery, thereby forming two study groups (Group A: before routine MLL; Group B: after routine MLL). Patients' demographics, disease characteristics, operative techniques, postoperative management and outcome were reviewed. RESULTS There were 64 patients in Group A and 35 patients in Group B. Ten (15.6%) patients from Group A compared to none from Group B developed chylous fistulae (p = 0.01). No significant morbidity was associated with MLL. Patients' and disease characteristics in both groups were not statistically different. Patients who developed chylous fistulae were managed with combinations of dietary modifications or complete bowel rest, total parenteral nutrition and prolonged abdominal drainage. Two patients underwent laparotomy and ligation of the chylous fistulae. CONCLUSION Chylous fistulae complicating abdominal neuroblastoma surgery disrupt neuroblastoma treatment. Meticulous MLL can be preventative if performed routinely before abdominal closure in the primary surgery.
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Abstract
Leakage of lymph from the lymphatic ducts causes chylothorax (CT) or chylous ascitis (CA). This may happen for unknown reasons during fetal life or after birth and may also be caused by trauma after thoracic surgery or by other conditions. Fetal CT and CA may be lethal particularly in cases with fetal hydrops that sometimes benefit of intra-uterine instrumentation. After birth, symptoms are related to the amount of accumulated fluid. Sometimes, severe cardio-respiratory compromise prompts active therapy. Most patients with CT or CA benefit from observation, rest, and supportive measures alone. Drainage of the fluid may be necessary, but then loss of protein, fat, and lymphoid cells introduce new risks and require careful replacement. Low-fat diets with MCT and parenteral nutrition decrease fluid production while allowing adequate nutritional input. If lymph leakage does not stop, secretion inhibitors like somatostatin or octreotide are prescribed, although there is only weak evidence of their benefits. Imaging of the lymphatic system is indicated when the leaks persist, but this is technically demanding in children. Shunting of the lymph from one body space to another by means of valved catheters, embolization of the thoracic duct, and/or ligation of the major lymphatics may occasionally be indicated in cases refractory to all other treatments.
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Affiliation(s)
- Juan C Lopez-Gutierrez
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain; Department of Pediatrics, Universidad Autonoma de Madrid, Madrid, Spain
| | - Juan A Tovar
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain; Department of Pediatrics, Universidad Autonoma de Madrid, Madrid, Spain.
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19
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Purkait R, Saha A, Tripathy I, Roy B. Congenital chylous ascites treated successfully with MCT-Based formula and octreotide. J Indian Assoc Pediatr Surg 2014; 19:175-7. [PMID: 25197199 PMCID: PMC4155638 DOI: 10.4103/0971-9261.136480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Medium chain triglyceride (MCT)-based diet, total parenteral nutrition (TPN) and repeated paracentesis are considered as supportive management for congenital chylous ascites (CCA). TPN is considered where therapy with oral MCT is poorly tolerated by the patient especially young infant with unstable hemodynamic. Surgery is recommended when medical therapy fails. Herein, we report a 2½-month-old infant with CCA, treated successfully with octreotide intravenous infusion after the initial failure to response to conventional conservative therapy with MCT-enriched formula and paracentesis.
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Affiliation(s)
- Radheshyam Purkait
- Department of Paediatric Medicine, Nil Ratan Sircar Medical College and Hospital, Acharya Jagadish Chandra Bose Road, Kolkata, West Bengal, India
| | - Ashis Saha
- Department of Paediatric Medicine, Nil Ratan Sircar Medical College and Hospital, Acharya Jagadish Chandra Bose Road, Kolkata, West Bengal, India
| | - Isita Tripathy
- Department of Paediatric Medicine, Nil Ratan Sircar Medical College and Hospital, Acharya Jagadish Chandra Bose Road, Kolkata, West Bengal, India
| | - Birendranath Roy
- Department of Paediatric Medicine, Nil Ratan Sircar Medical College and Hospital, Acharya Jagadish Chandra Bose Road, Kolkata, West Bengal, India
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20
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Moreira DDAR, Santos MM, Tannuri ACA, Tannuri U. Congenital chylous ascites: a report of a case treated with hemostatic cellulose and fibrin glue. J Pediatr Surg 2013; 48:e17-9. [PMID: 23414895 DOI: 10.1016/j.jpedsurg.2012.11.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 11/14/2012] [Accepted: 11/15/2012] [Indexed: 10/27/2022]
Abstract
We report a case of an infant with recurrent chylous ascites who was unresponsive to conventional medical treatment. An exploratory laparotomy revealed no macroscopically visible sites of lymph leakage that could be ligated. Lymph exudation was noted in areas near the subhepatic recess and in the lesser sac surrounding the pancreas, which was not amenable to suture. The treatment consisted of the placement of a hemostatic mesh composed of oxidized cellulose (Surgicel) on these areas, with a thin layer of fibrinogen/thrombin glue over the mesh (Tissucol). The cellulose mesh allowed for greater adhesion of the fibrin glue to the diseased tissues. The patient had no recurrence of ascites and is currently 20 months old, with good weight-height gain, and free of ascites.
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Affiliation(s)
- Daniel de Albuquerque Rangel Moreira
- Pediatric Surgery Division, Pediatric Liver Transplantation Unit, Laboratory of Research in Pediatric Surgery (LIM 30), University of Sao Paulo Medical School, Sao Paulo, Brazil
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Abstract
PURPOSE The purpose of the present study was to evaluate the prognostic factors and review the outcome of primary isolated fetal ascites. METHODS A retrospective cohort study was conducted for fetuses with primary isolated ascites with a prenatal diagnosis between 1994 and 2009. The patients were divided into the favorable group (Group I) whose ascites were resolved by medical treatment alone and an unfavorable group (Group II) who required surgical intervention after birth due to refractory ascites. RESULTS There were seven patients in Group I and five patients in Group II. Six of seven patients who developed ascites after 30 weeks' gestation were categorized in Group I, and four of five infants who developed ascites before 30 weeks' gestation were categorized in Group II. There was a negative correlation between the gestational age at diagnosis and the severity of the fetal abdominal distention. In Group II, the ascites resolved in two cases and was reaccommodated in another two cases after surgery. An infant with trisomy 21 received continuous drainage and eventually died of infection. CONCLUSIONS The prognosis of primary isolated fetal ascites can be predicted based on the gestational age at diagnosis and the severity of the fetal abdominal distention.
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Spagnol L, Conforti A, Valfrè L, Morini F, Bagolan P. Preoperative administration of Sudan III and successful treatment of persistent chylous ascites in a neonate. J Pediatr Surg 2011; 46:994-7. [PMID: 21616268 DOI: 10.1016/j.jpedsurg.2011.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 01/07/2011] [Accepted: 01/10/2011] [Indexed: 11/20/2022]
Abstract
Congenital chylous ascites is a rare entity, and surgical treatment is confined to selected intractable cases. We report 2 cases of refractory congenital chylous ascites successfully treated with preoperative administration of lipophilic dye (Sudan III) followed by abdominal systematic surgical exploration, cauterization, and fibrin glue application.
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Affiliation(s)
- Lorna Spagnol
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Research Hospital, 00165 Rome, Italy
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Steinemann DC, Dindo D, Clavien PA, Nocito A. Atraumatic chylous ascites: systematic review on symptoms and causes. J Am Coll Surg 2011; 212:899-905.e1-4. [PMID: 21398159 DOI: 10.1016/j.jamcollsurg.2011.01.010] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 01/10/2011] [Accepted: 01/11/2011] [Indexed: 12/14/2022]
Affiliation(s)
- Daniel C Steinemann
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
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24
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Rahman N, De Coppi P, Curry J, Drake D, Spitz L, Pierro A, Kiely E. Persistent ascites can be effectively treated by peritoneovenous shunts. J Pediatr Surg 2011; 46:315-9. [PMID: 21292080 DOI: 10.1016/j.jpedsurg.2010.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 11/04/2010] [Indexed: 11/19/2022]
Abstract
AIM The aim the study was to review our experience and determine the effectiveness of peritoneovenous shunts in the management of persistent ascites. METHODS A retrospective review of all patients who had a peritoneovenous shunt inserted for persistent ascites in our institution over 32 years (1977-2010) was performed. RESULTS Thirty-one peritoneovenous shunts were inserted into 25 patients. Records from 22 were available. Median age was 34 months (range, 1 month-12 years), with median duration of ascites of 1.75 months (range, 3 weeks-2.5 years). Sixteen had previous abdominal surgery, whereas one had previous thoracic surgery. Other underlying pathologies included hepatitis (n = 2), lymphohistiocytosis, lymphatic hypoplasia, and carcinomatosis. One was regarded as idiopathic. Previous management consisted of paracentesis (n = 15), dietary modification (n = 11), diuretics (n = 9), and total parenteral nutrition (TPN) (n = 4). One underwent fetal drainage of ascites. No intraoperative complications occurred. Eight (36%) had postoperative complications, including shunt occlusion (n = 2), pulmonary edema (n = 2), infection (n = 2), and wound leakage (n = 1). One developed a varix following shunt removal. The ascites resolved after shunting in 20 (91%) of the 22 children. Four died from their underlying pathology. In children with malignancy, the shunt allowed prompt resumption in treatment schedule. CONCLUSION This represents the largest series of children receiving peritoneovenous shunt for persistent ascites. It is a safe and effective treatment which should be considered early.
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Affiliation(s)
- Nisha Rahman
- Great Ormond Street Hospital and UCL Institute of Child Health, London WC1N 3JH, United Kingdom
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25
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Melo-Filho AA, Souza IJN, Leite CAC, Leite RD, Colares JHF, Correia JMS. Refractory congenital chylous ascites. Indian J Pediatr 2010; 77:1335-7. [PMID: 20821276 DOI: 10.1007/s12098-010-0193-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 08/19/2010] [Indexed: 10/19/2022]
Abstract
Refractory congenital chylous ascites (CCA) is an uncommon clinical condition. Few cases have been described and no gold standard treatment has been defined so far. This report describes a case of refractory CCA in a newborn child which was treated by surgery. Preoperative lower-limb lymphoscintigraphy associated with intraoperative patent blue testing and fibrin glue application were useful in order to provide a successful outcome.
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Affiliation(s)
- Antônio Aldo Melo-Filho
- Department of Surgery, Medical School, Federal University of Ceará (UFC), Rua Professor Costa Mendes, 1608, 3° andar, Rodolfo Teófilo, CEP: 60430-140, Fortaleza, Ceará, Brazil.
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Densupsoontorn N, Jirapinyo P, Aanpreung P, Laohapensang M, Parichatikanond P. Congenital chylous ascites: the roles of fibrin glue and CD31. Acta Paediatr 2009; 98:1847-9. [PMID: 19627262 DOI: 10.1111/j.1651-2227.2009.01432.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED A 6-month-old male infant who presented with abdominal distension and congenital chylous ascites was diagnosed. He was initially refractory to conservative therapy, and then was completely cured with ligation of megalymphatics and fibrin glue application. Immunoperoxidase staining for CD31 on the biopsied peritoneal tissues highlighted the lining cells of lymphatic spaces, which indicated lymphangiectasia. CONCLUSION This case emphasizes the effectiveness of lymphatic ligation of the retroperitoneal megalymphatics in conjunction with fibrin glue application to cure congenital lymphangiectasia.
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Affiliation(s)
- N Densupsoontorn
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Soto R, García I, Hinojosa C, Torre A. Refractory Chylous Ascites. Gastroenterology Res 2008; 1:57-59. [PMID: 27994709 PMCID: PMC5154218 DOI: 10.4021/gr2008.11.1252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2008] [Accepted: 12/03/2008] [Indexed: 12/23/2022] Open
Abstract
A 34-year-old woman with primary chylous ascites due to lymphangiectasias was treated with sclerotherapy of dilated lymphatics and a lymphovenous shunt. She was referred to our institution after a thorough diagnostic and therapeutic approach in her community hospital. After four weeks of intensive diagnostic study, no secondary etiology for her chylous disorder was established. Conservative treatment did not prove useful, and a laparotomy was done. Lymphangiectasias and a lymphatic leak were demonstrated, but primary closure was ineffective. A second surgery with derivative intention was done, but six months later ascites recurred. A new sclerosing surgery was done; afterwards, the patient remained free of symptoms. Primary chyloperitoneum is a rare and complex disorder; its treatment and outcome depend on a multidisciplinary approach and an experienced medical team.
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Affiliation(s)
- Rodrigo Soto
- Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran" Vasco de Quiroga # 15, Col. Seccion XVI, Tlalpan, D. F. CP 14000, Mexico
| | - Ignacio García
- Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran" Vasco de Quiroga # 15, Col. Seccion XVI, Tlalpan, D. F. CP 14000, Mexico
| | - Carlos Hinojosa
- Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran" Vasco de Quiroga # 15, Col. Seccion XVI, Tlalpan, D. F. CP 14000, Mexico
| | - Aldo Torre
- Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran" Vasco de Quiroga # 15, Col. Seccion XVI, Tlalpan, D. F. CP 14000, Mexico
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Yeo MS, Tan LG, Chang SK. Postoperative chylous ascites: An institutional experience over two years. SURGICAL PRACTICE 2008. [DOI: 10.1111/j.1744-1633.2008.00415.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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