First Case of Chylous Ascites after Laparoscopic Myomectomy: A Case Report with a Literature Review

Chyle and Bile Leak Following Open Cholecystectomy: A Rare Complication

Gallstone disease is extremely common and frequently and safely treated by cholecystectomy. Chyle leak is a rare but significant side effect of many abdominal surgeries with rarely reported post-cholecystectomy. In this case, we report a 78-year-old lady with multiple comorbidities and symptomatic gallstones who underwent open cholecystectomy complicated by bile and chyle leak, which was successfully managed with endoscopic retrograde cholangiopancreatography (ERCP) and stenting for bile leak and conservative management for the chyle leak, which included drainage, low-fat diet, and octreotide.

Milky Ascites: A Diagnostic Dilemma

Chylous ascites is a milky-appearing, triglyceride-rich fluid within the abdominal cavity. It is a rare finding that arises from the disruption of the lymphatic system and can be caused by a wide variety of pathologies. Here, we present a diagnostically challenging case of chylous ascites. In this article, we discuss the pathophysiology and various etiologies of chylous ascites, explore the diagnostic tools available, and highlight the management strategies implemented in this rare finding.

Chylous ascites following repair of total anomalous pulmonary venous connection coexisting with a persistent left superior vena cava in a neonate: a case report

Chylous ascites refers to the accumulation of lymphatic fluid in the peritoneal cavity. The causes of chylous ascites are various, and commonly include traumatic injury and obstruction, which disrupt the lymphatic system. In addition, cardiothoracic surgery may injure the thoracic duct and lead to chylothorax. However, there are very few reported cases of isolated chylous ascites developing following cardiothoracic surgery. In this paper, we report a case of postoperative chylous ascites in a full-term neonate. The infant underwent cardiothoracic surgery via thoracotomy to repair total anomalous pulmonary venous connection coexisting with a persistent left superior vena cava on day of life 17, and there was a significant increase in abdominal girth on postoperative day 12 (day of life 29). Abdominal ultrasound revealed an 8 mm thick ascites without pleural effusion. Abdominal paracentesis was performed and the milky-white peritoneal fluid was positive for Sudan III staining and the chylous test. The triglyceride concentration of the ascitic fluid was 691 mg/dL and the concentration of protein was 39.4 g/L. Additionally, the ascitic fluid also contained 6 360×10⁶/L of white blood cells, predominantly lymphocytes. These results suggested the infant developed chylous ascites. Conservative management with fasting and medium-chain triglycerides-based formula successfully resolved the chylous ascites without reoccurrence. We present our experience of this rare condition and discuss the possible causes of chylous ascites in this case.

Association Between Neoadjuvant Chemoradiotherapy and Intractable Serous Ascites After Pancreaticoduodenectomy for Pancreatic Cancer

BACKGROUND

Intractable serous (not chylous) ascites (IA) that infrequently develops early following pancreaticoduodenectomy (PD) for pancreatic cancer is a life-threatening problem. The relationship between neoadjuvant chemoradiotherapy (NACRT) for pancreatic cancer and the incidence of IA following PD has not been evaluated. This study aims to identify the risk factors associated with IA that develops early after PD for pancreatic cancer.

METHODS

We retrospectively identified 94 patients who underwent PD for pancreatic cancer at the Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan, from April 2012 to March 2020. Data on 29 parameters were obtained from medical records. Univariate and multivariate analyses were conducted to identify independent risk factors. Levels of serum albumin were compared before and after NACRT to analyze its effect. Survival analysis was also conducted.

RESULTS

Of the 92 patients included in this study, 8 (8.70%) were categorized into the IA group. Multivariate analysis identified NACRT [odds ratio (OR) 27, 95% confidence interval (CI) 1.87-394, p = 0.016)] and hypoalbuminemia (≤ 1.6 g/dl) just after the operation (OR 50, 95% CI 1.68-1516, p = 0.024) as risk factors. The level of serum albumin was significantly decreased following NACRT. The IA group had poorer prognosis than the control group.

CONCLUSIONS

IA is a serious problem that aggravates patient's prognosis. Postoperative lymphatic leak might be a trigger of IA. NACRT was a major risk factor, followed by hypoalbuminemia caused by various reasons. These factors may act synergistically and cause IA.