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Hoan L, Cuong NN, My TTT, Luu DT, Long H, Hoa TQ, Hoang N, Hoan NC. Thoracic duct stent treatment for chyle leak after nephrectomy. Radiol Case Rep 2023; 18:3199-3202. [PMID: 37448602 PMCID: PMC10338187 DOI: 10.1016/j.radcr.2023.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Chyle leak is a rare and serious condition caused by damaged lymphatic vessels. It can occur after retroperitoneal surgery involving extensive lymphadenectomy for kidney cancer. Besides lymphatic channel damage, the obstruction of the thoracic duct worsens the leakage. Managing patients with thoracic duct obstruction and postsurgical chyle leakage is challenging due to limited data on how to handle this condition. In this case report, a 28-year-old female patient underwent left nephrectomy for left kidney cancer. Three days after the surgery, milky fluid drained from the left renal fossa. Conservative treatment failed, and further examination through magnetic resonance lymphangiography revealed the absence of the thoracic duct and contrast extravasation at the left renal fossa. Lymphangiography confirmed distal thoracic duct obstruction. The patient's condition was successfully managed by using thoracic duct stenting. This report contributes to the understanding that thoracic duct obstruction can lead to lymphatic collateral circulation within the abdomen, thereby increasing the risk of postoperative chylous leak.
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Affiliation(s)
- Le Hoan
- Respiratory Department, Hanoi Medical University, Hanoi, Viet Nam
| | - Nguyen Ngoc Cuong
- Radiology Center, Hanoi Medical University Hospital, Hanoi, Viet Nam
| | - Thieu Thi Tra My
- Radiology Center, Hanoi Medical University Hospital, Hanoi, Viet Nam
| | - Doan Tien Luu
- Radiology Center, Hanoi Medical University Hospital, Hanoi, Viet Nam
| | - Hoang Long
- Surgery Department, Hanoi Medical University, Hanoi, Viet Nam
| | - Tran Quoc Hoa
- Surgery Department, Hanoi Medical University, Hanoi, Viet Nam
| | - Nguyen Hoang
- Surgery Department, Hanoi Medical University, Hanoi, Viet Nam
| | - Nguyen Cong Hoan
- Outpatient Department, Hanoi Medical University Hospital, Hanoi, Viet Nam
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Buksh O, Almalki AM, Jar A, Alzahrani H, Bitar H, Al-Akraa M. Chylous Ascites Following Laparoscopic Donor Nephrectomy: A Case Report. Cureus 2023; 15:e38416. [PMID: 37273336 PMCID: PMC10233342 DOI: 10.7759/cureus.38416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Chylous ascites is a form of peritoneal fluid accumulation that can arise from trauma or lymphatic obstruction. In this report, we present the first case of chylous ascites following laparoscopic donor nephrectomy in our high-volume kidney transplant center. The patient presented to the emergency department three weeks post-procedure with complaints of abdominal distention and discomfort, accompanied by constipation and nausea. Radiological confirmation of ascites was followed by paracentesis, which yielded 20 mL of milky fluid that was analyzed and confirmed as chylous ascites. A subsequent pigtail drain was inserted, resulting in a total drainage of 4 L of fluid. Chylous ascites is a rare complication of abdominal surgeries, with higher body mass index and the American Society of Anesthesiologists physical status score system being significant risk factors. Conservative management involving diet modification is the initial therapy, with percutaneous drainage or more aggressive surgical interventions considered if conservative measures are not effective, with high success rates reported for these interventions. Here, we report a case of chylous ascites following donor nephrectomy as the first case reported from our region.
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Affiliation(s)
- Omar Buksh
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Abdullah M Almalki
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Anfal Jar
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Hani Alzahrani
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Hussam Bitar
- Department of General Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Mahmoud Al-Akraa
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
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Hoa TQ, Cuong NN, My TTT, Linh LT, Hoan L, Canh PH, Tinh TQ, Chi TNK, Luu DT, Long H. Chylous ascites after donor nephrectomy: MR lymphangiography and lymphatic embolization treatment. Radiol Case Rep 2023; 18:1029-1032. [PMID: 36684632 PMCID: PMC9849999 DOI: 10.1016/j.radcr.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 01/07/2023] Open
Abstract
Chylous ascites results from the leakage of lipid-rich lymphatic fluid into the peritoneal cavity. Most postsurgical chylous ascites occurs following abdominal aortic surgeries. However, rarely, it is a complication after laparoscopic donor nephrectomy. Postsurgical chylous ascites are often managed with conservative treatment or surgery, but lymphatic embolization may be required. Here, we presented a 45-year-old male patient who was referred for abdominal distension for 1 week after left donor nephrectomy. The drain fluid was milky and fluid analysis revealed high concentrations of triglycerides and chylomicron, confirming diagnosis of chylous ascites. The patient was treated with conservative therapy including a low-fat diet and fluid drainage but continued to have high draining output (up to 1500-2000 mL/24 h). He underwent magnetic resonance lymphangiography and intranodal lymphangiography, revealing extravasation of contrast into the abdomen and the left renal fossa. We embolized the interstitial lymphatic of the left retroperitoneal and lymphatic vessels leak. The patient was discharged from hospital at the fifth day after intervention. In this article, we demonstrate lymphatic lesions, the safety, and success of this technique.
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Affiliation(s)
- Tran Quoc Hoa
- Urology Surgery Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Nguyen Ngoc Cuong
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam,Corresponding author.
| | - Thieu Thi Tra My
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Le Tuan Linh
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Le Hoan
- Respiratory Department, Hanoi Medical University, Hanoi, Vietnam
| | - Pham Hong Canh
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Trieu Quoc Tinh
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Tran Nguyen Khanh Chi
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Doan Tien Luu
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Hoang Long
- Urology Surgery Department, Hanoi Medical University Hospital, Hanoi, Vietnam
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Sheela C, Thomas R, Yadav M, Sasidharan K. Chylous ascites following laparoscopic donor nephrectomy: Report of a case and a brief overview. Indian J Transplant 2023. [DOI: 10.4103/ijot.ijot_67_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Gibb J, Tanasescu G, Phan YC, Osborn P, Robinson R. A rare complication of retroperitoneoscopic radical nephrectomy: chylous ascites. Br J Hosp Med (Lond) 2022; 83:1-3. [DOI: 10.12968/hmed.2021.0420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Julia Gibb
- Department of Urology, Queen Alexandra Hospital, Portsmouth, UK
| | | | - Yih Chyn Phan
- Department of Urology, Queen Alexandra Hospital, Portsmouth, UK
| | - Peter Osborn
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK
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Pan F, Richter GM, Do TD, Kauczor HU, Klotz R, Hackert T, Loos M, Sommer CM. Treatment of Postoperative Lymphatic Leakage Applying Transpedal Lymphangiography - Experience in 355 Consecutive Patients. ROFO-FORTSCHR RONTG 2022; 194:634-643. [PMID: 35081648 DOI: 10.1055/a-1717-2467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Report of experience from a single institution in treating postoperative lymphatic leakage (PLL) applying conventional transpedal lymphangiography (TL). MATERIALS AND METHODS 453 patients with the initial diagnosis of PLL receiving TL between 03/1993 and 09/2018 were identified in the database. Only patients with confirmed PLL were included in the study. The technical success, safety, and treatment success of TL were evaluated. Independent predictors of TL treatment failure were examined using univariate and multivariate logistic regression analysis. RESULTS 355 consecutive patients (218 men, 137 women; median age of 62 years) who underwent TL for PLL (e. g., chylothorax) after ineffective conservative treatment were included. The median time between causal surgery and TL was 27 days. The median technical success rate of TL was 88.5 %, with a median volume of Lipiodol of 10.0 ml. No complication of TL was recorded. Three groups were defined according to the different clinical courses: group A (41/355, 11.5 %) - TL with technical failure; group B (258/355, 72.7 %) - "therapeutic" TL alone with technical success; and group C (56/355, 15.8 %) - "diagnostic" TL with simultaneously invasive treatment (incl. surgical revision and percutaneous sclerotherapy). Treatment success rate and median time to treatment success were higher in group C than in group B, but without significant differences (64.3 % vs. 61.6 %, p = 0.710; six vs. five days, p = 0.065). Univariate and multivariate logistic regression analyses for group B confirmed drainage volume (> 500 ml/d) and Lipiodol extravasation as independent predictors of TL clinical failure (odds ratios [ORs] of 2.128 and 2.372 [p = 0.005 and p = 0.003, respectively]). CONCLUSION TL is technically reliable, safe, and effective in treating PLL. When conservative treatment fails, TL can be regarded as the next treatment option. KEY POINTS · TL is technically reliable, safe, and effective for treating PLL.. · When conservative treatment fails, TL can be regarded as the next treatment option.. · Drainage volume > 500 ml/day is an independent predictor of clinical failure after TL.. · Lipiodol extravasation is an independent predictor of clinical failure after TL.. CITATION FORMAT · Pan F, Richter GM, Do TD et al. Treatment of Postoperative Lymphatic Leakage Applying Transpedal Lymphangiography - Experience in 355 Consecutive Patients. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1717-2467.
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Affiliation(s)
- Feng Pan
- Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.,Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Goetz M Richter
- Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart Katharinenhospital, Stuttgart, Germany
| | - Thuy Duong Do
- Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Rosa Klotz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Germany
| | - Martin Loos
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Germany
| | - Christof M Sommer
- Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.,Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart Katharinenhospital, Stuttgart, Germany.,Department of Nuclear Medicine, University Hospital Heidelberg, Germany.,Clinic of Radiology and Neuroradiology, Sana Clinics Duisburg, Germany
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Bhandari G, Tiwari V, Gupta A, Bhargava V, Malik M, Gupta A, Bhalla AK, Rana DS. Chylous Ascites after Laparoscopic Donor Nephrectomy: Case Report. Indian J Nephrol 2021; 31:482-484. [PMID: 34880560 PMCID: PMC8597792 DOI: 10.4103/ijn.ijn_391_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/22/2020] [Accepted: 10/06/2020] [Indexed: 11/22/2022] Open
Abstract
Chylous ascites refers to the accumulation of chyle in the abdominal cavity. Postoperative chylous ascites is most commonly associated with abdominal aortic surgeries. However, it is a rare complication following laparoscopic nephrectomy. It causes loss of fat, protein, and antibodies causing malnutrition and immunodeficiency. Thus, it is important to treat it as early as possible. We hereby report a case of chylous ascites following laparoscopic donor nephrectomy. A 55-year-old female was admitted at our center 2 weeks after undergoing left laparoscopic donor nephrectomy with abdominal distension and constipation. USG abdomen revealed free fluid in the abdomen. Paracentesis revealed chylous ascites. The patient was started on conservative treatment, including a diet rich in proteins and low in fats; conservative treatment, however, was unsuccessful. Lymphangiography and subsequent embolization of the defect were done, and she made a full recovery.
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Affiliation(s)
- Gaurav Bhandari
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Vaibhav Tiwari
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Anurag Gupta
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Vinant Bhargava
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Manish Malik
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashwani Gupta
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | | | - D S Rana
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
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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. Afr J Urol 2021. [DOI: 10.1186/s12301-020-00116-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Tawfeeq H, Lim SW, Lapsia S, Al-Islam S. Iatrogenic chylous collection post laparoscopic nephrectomy. BJR Case Rep 2020; 6:20190058. [PMID: 33029360 PMCID: PMC7526993 DOI: 10.1259/bjrcr.20190058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 01/19/2020] [Accepted: 01/22/2020] [Indexed: 11/05/2022] Open
Abstract
With the increasing number of laparoscopic nephrectomies, trauma to lymphatic channels has become an increasingly recognised complication. Early diagnosis and prompt management are key to avoid highly morbid sequelae including severe malnutrition and immunodeficiency. This case reviews the important complication of a retroperitoneal chylous collection following laparoscopic radical nephrectomy.
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Affiliation(s)
| | - Su W Lim
- Royal Blackburn Hospital, Blackburn, England
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