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Su P, Zhang Z. Nano Carbon Tracer in the Repairing of Congenital Abdominal Chylorus Leakage. Indian J Pediatr 2024; 91:294-296. [PMID: 37129755 DOI: 10.1007/s12098-023-04557-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/06/2023] [Indexed: 05/03/2023]
Abstract
Congenital chylous ascites (CCA) is a rare cause of ascites in newborn infants. The main causes include congenital lymphatic obstruction due to atresia or stenosis of the major lacteals, mesenteric cysts and lymphangiomatosis. The mainstay of treatment for CCA is conservative management including medium-chain triglycerides (MCT)-based diet or total parenteral nutrition (TPN), and the addition of octreotide. Surgical exploration is reserved for those cases in whom conservative management has failed. The core problem of chylous abdominal surgery is to find the leakage; once the exact chylous leakage is found, the problem will be solved. The authors used a new carbon nanopartides material to accurately locate the location of chylous leakage. The operation is simple and fast, easy to use, and the effect is remarkable.
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Affiliation(s)
- Pengjun Su
- Department of Pediatric Surgery, Shengjing Hospital, Nanhu Branch, China Medical University, Sanhao Street 36, Shenyang, 110004, China.
| | - Zhibo Zhang
- Department of Pediatric Surgery, Shengjing Hospital, Nanhu Branch, China Medical University, Sanhao Street 36, Shenyang, 110004, China
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Matsubara D, Komatsu S, Kanazawa H, Hamada S, Uozumi Y, Nishiko M, Konishi T, Soga K, Shimomura K, Ikeda J, Taniguchi F, Shioaki Y. [Laparoscopic Surgery for Delayed Chylous Ascites in Unresectable Gastric Cancer Patient-A Case Report]. Gan To Kagaku Ryoho 2024; 51:81-83. [PMID: 38247099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Chylous ascites is a rare post operative complication after gastrectomy, which commonly occurs in early postoperative period. Here, we successfully treated a patient with unresectable gastric cancer who occurred chylous ascites 9 months after first surgery and underwent laparoscopic surgery for chylous ascites. Since prolonged chylous ascites may cause malnutrition, surgical treatment should be considered for refractory chylous ascites.
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Tsuzaka S, Aiyama T, Kamachi H, Kakisaka T, Orimo T, Nagatsu A, Asahi Y, Maeda T, Kamiyama T, Taketomi A. Lymphaticovenous anastomosis for treatment of refractory chylous ascites: A case report. Microsurgery 2023; 43:606-610. [PMID: 37016794 DOI: 10.1002/micr.31042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/17/2023] [Accepted: 03/09/2023] [Indexed: 04/06/2023]
Abstract
Chylous ascites, the leakage of lymphatic fluid into the abdominal cavity caused by lymphatic fluid stasis or lymphatic vessel damage, can be treated by lymphaticovenous anastomosis (LVA). We report rarely performed abdominal LVA to treat a case of refractory ascites possibly caused by ligation of the thoracic duct and pleurodesis in a man aged 60 years requiring weekly ascites drainage. Ligation was abandoned because the leakage site was not determined. The greater omentum (GO) was generally edematous and showed lymphatic effusion by gross appearance, and was considered suitable for LVA. We performed once LVA in the lymphatic vessels and veins of the GO using common microsurgical instrumentation and lateral anastomosis. Lymphatic vessels in the omentum were dilated to 2-3 mm, and LVA was simple. After LVA, GO edema improved. Postoperatively, the patient developed paralytic ileus, which improved within a few days, and the patient was discharged without any increase in ascites after starting to diet. One year post-surgery, there was no recurrence of ascites. LVA at the GO may be effective for the treatment of refractory chylous ascites because of its absorptive lymphatic draining capabilities and large transverse vessels.
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Affiliation(s)
- Shoichi Tsuzaka
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, 060-8638, Hokkaido, Japan
| | - Takeshi Aiyama
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, 060-8638, Hokkaido, Japan
| | - Hirofumi Kamachi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, 060-8638, Hokkaido, Japan
| | - Tatsuhiko Kakisaka
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, 060-8638, Hokkaido, Japan
| | - Tatsuya Orimo
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, 060-8638, Hokkaido, Japan
| | - Akihisa Nagatsu
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, 060-8638, Hokkaido, Japan
| | - Yoh Asahi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, 060-8638, Hokkaido, Japan
| | - Taku Maeda
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, 060-8638, Hokkaido, Japan
| | - Toshiya Kamiyama
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, 060-8638, Hokkaido, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, 060-8638, Hokkaido, Japan
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Klifto KM, Card EB, Itkin M, Kovach SJ. Microsurgical Peritoneovenous Bypass for the Treatment of Recalcitrant Chylous Ascites. Plast Reconstr Surg 2023; 152:433-439. [PMID: 36727803 DOI: 10.1097/prs.0000000000010244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND New treatments for recalcitrant chylous ascites are needed to avoid sequelae associated with increased intraabdominal pressures, chyle loss, and diminished quality of life. An autologous microsurgical technique was developed to treat recalcitrant chylous ascites and restore normal physiology. METHODS A retrospective case series was performed for patients with recalcitrant chylous ascites surgically treated from 2018 to 2020. The authors included all patients with recalcitrant chylous ascites refractory to current standard-of-care interventions such as diet modifications, pharmacologic therapies, and peritoneovenous mechanical shunts. All were treated with microsurgical peritoneovenous bypass with a minimum follow-up of 12 months. RESULTS Six patients were included over a 2-year period. Surgery was aborted for two patients (33%) with intraoperative venous reflux of the deep inferior epigastric vein, negative on preoperative ultrasound. One patient had a successful reoperation using the contralateral greater saphenous vein; the other elected for a chronic indwelling drain for chyle drainage. Among the five successful procedures (83%), ascites drainage decreased from a median preoperative volume of 1 L/day to postoperative volume of 0.06 L/day. Median hospital length of stay was 7 days (range, 212 to 194 days). Three patients had one complication each, including vancomycin-resistant Enterococcus , spontaneous bacterial peritonitis, and pulmonary embolism. All complications resolved with additional interventions. Median follow-up was 13.5 months (range, 12 to 27 months). CONCLUSION Microsurgical peritoneovenous bypass was a reliable and reproducible autologous surgery for the treatment of recalcitrant chylous ascites at a minimum follow-up of 12 months. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Kevin M Klifto
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine
- Division of Plastic Surgery, Department of Surgery
| | | | - Maxim Itkin
- Department of Radiology, University of Pennsylvania Perelman School of Medicine
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Kalia S, Narkhede A, Yadav AK, Bhalla AK, Gupta A. Retrograde transvenous selective lymphatic duct embolization in post donor nephrectomy chylous ascites. CEN Case Rep 2022; 11:1-5. [PMID: 34218419 PMCID: PMC8811106 DOI: 10.1007/s13730-021-00618-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 06/15/2021] [Indexed: 12/20/2022] Open
Abstract
Chylous ascites is a rare, potentially sinister complication in post donor nephrectomy patients which may cause significant morbidity in form of severe malnutrition and an immuno-compromised state. We present two patients with post donor nephrectomy-related chylous leaks who failed conservative treatment. In both cases, lymphangiography was done first to detect the chylous leak site in the left renal fossa, and thereafter transvenous retrograde approach via left subclavian vein with selective lymphatic duct embolization of chylous leak was done with coils and glue successfully. Chylous ascites resolved in both patients after the embolization. Hence retrograde transvenous embolization technique appears to be an effective management option for refractory chylous leaks.
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Affiliation(s)
- Shekhar Kalia
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Amey Narkhede
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ajit Kumar Yadav
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India.
| | | | - Arun Gupta
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
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Jangjoo A, Kalantari ME, Rezapanah A, Norouzi Asl S, Dalili A, Zandbaf T. Chylous Ascites Following Gastric Bypass; Lesser-Known and Unusual Complication. Obes Surg 2022; 32:1352-1355. [PMID: 35043360 DOI: 10.1007/s11695-021-05834-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Ali Jangjoo
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Alireza Rezapanah
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sina Norouzi Asl
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Dalili
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tooraj Zandbaf
- Department of General Surgery, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran.
- 22 Bahman Hospital, Tollab Ave, Mashhad, Iran.
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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: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Manco G, Caramaschi S, Prestigiacomo G, Rossi EG, Fenocchi S, Gelmini R. Idiopathic chylous peritonitis mimicking acute appendicitis A case report. Ann Ital Chir 2021; 10:S2239253X21033880. [PMID: 33843723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We report an uncommon case of idiopathic acute chylous peritonitis mimicking an acute appendicitis in a 30-year-old female patient with a 2-day history of abdominal pain, nausea and vomiting. Chylous ascites is a rare form of ascites characterized by the presence of a milky fluid rich in triglycerides. It occurs as a result of a damage to the lymphatic system due to trauma or other benign and malignant pathologies. Although the most common clinical presentation is progressive painless abdominal distension, less frequently it can cause acute abdomen symptoms. The management is based on identifying and treating the underlying pathology. Aspiration of the fluid and drainage are the only therapy required if a clinically diagnosis cannot be made. Surgical laparoscopic exploration is necessary to make a diagnosis and to treat effectively acute abdomen cases.In the absence of a significant determining pathology, we talk about idiopathic chylous peritonitis. KEY WORDS: Chylous ascites, peritonitis, laparoscopy.
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Fatah A, Audiyanto T. Refractory Chylous Ascites with Chylothorax and an Umbilical Hernia in a Patient Ineligible for a Transjugular Intrahepatic Portosystemic Shunt. Am J Case Rep 2020; 21:e925026. [PMID: 32865187 PMCID: PMC7483474 DOI: 10.12659/ajcr.925026] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/22/2020] [Accepted: 06/26/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Chylous ascites is a rare condition, which is defined by accumulation of a milky fluid due to high triglyceride levels. It is most commonly secondary to malignancy, liver cirrhosis, infection, and tuberculosis. CASE REPORT A 21-year-old woman from rural Indonesia, came to the hospital with chronic dyspnea and a history of repeated paracentesis. Six years ago, she was diagnosed with chronic hepatitis B. For the past 2 years, she had complaints of progressive dyspnea and increased abdominal swelling. On examination, there was dullness on chest percussion and decreased breath sounds. Shifting dullness was positive on abdominal examination. Paracentesis and thoracentesis were performed and showed high triglyceride levels. She underwent an abdominal computed tomography scan and was diagnosed with liver cirrhosis, complicated with chylous ascites and chylothorax. Repeated paracentesis was performed as a therapeutic approach; she had strict diet guidelines, and was prescribed octreotide, furosemide, spironolactone, and albumin. Despite this treatment, two years later, she developed an umbilical hernia complicated with ulceration. Hernia repair was not possible due to her comorbidities. She was indicated for a transjugular intrahepatic portosystemic shunt (TIPS) for the refractory chylous ascites. However, this could not be performed as the patient could not afford this expensive procedure, which was not covered by insurance. CONCLUSIONS Management of refractory chylous ascites is challenging, especially in underdeveloped countries due to socioeconomic problems and limited health care facilities. Although TIPS is indicated in refractory chylous ascites, repeated paracentesis can be useful as an alternative method.
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Affiliation(s)
- Abraham Fatah
- Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
| | - Theo Audiyanto
- Department of Internal Medicine, Siloam General Hospital, Tangerang, Indonesia
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Zetelová A, Rovný I, Kala Z, Moravčík P, Minář L. The Use of Indocyanin Green for Peroperative Diagnostic of Chylous Ascites and Autologous Tissue Glue (Vivostat) for the Treatment. Klin Onkol 2020; 33:145-149. [PMID: 32303135 DOI: 10.14735/amko2020145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Chylous ascites or chyloperitoneum can be caused by peroperative injury of the lymphatic pathways; the lymph is accumulated in the abdominal cavity. The incidence of chylous ascites varies according to the type of surgery and the extent of the lymphadenectomy. The first choice of treatment is a conservative procedure - total parenteral nutrition or a strict low-fat diet. If this fails, a surgical revision is indicated. However, this is often difficult due to postoperatively altered terrain and the chronic presence of pathological secretion in the abdominal cavity. The application of a fat emulsion or indocyanine green (ICG) to the lymphatic drainage area may help identify the lymph source. Nowadays, ICG is used in various clinical indications, e.g. evaluation of liver function, angiography in ophthalmology, assessment of blood supply to the tissues, search for lymph nodes in oncological surgeries. The advantage of ICG lymphography is the possibility of observing the source of the leak in real time directly during surgical revision. CASE REPORT A polymorbid 66-year-old patient after radical oncogynaecological surgery with aortopelvic lymphadenectomy was postoperatively complicated by persistent, high-volume chylous ascites, not responding to conservative treatment. Therefore, we performed surgical revision of the abdominal cavity and successful treatment of the leak source using ICG peroperative lymphography and subsequent application of Vivostat autologous tissue glue to this area. CONCLUSION High-volume consistent chylous ascites is not a frequent postoperative complication but it has a significant impact on the quality of life, nutritional status of the patient and further patient prognosis. The treatment is strictly individual. The first choice should be a conservative approach. Where that fails, a difficult surgical revision is indicated. Today, however, the surgeon can be helped by modern technologies such as fluorescent navigated surgery or treatment of the source with autologous tissue adhesives. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedice papers.
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Goel A, Gaur MK, Garg PK. Milky Mesentery: Acute Abdomen with Chylous Ascites. Indian Pediatr 2018; 55:909-910. [PMID: 30426960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Clinical presentations of intestinal lymphangiectasia include pitting edema, chylous ascites, pleural effusion, diarrhea, malabsorption and intestinal obstruction. CASE CHARACTERISTICS An 8-year-old male child presented to the emergency department with clinical features of peritonitis, raising suspicion of appendicular or small bowel perforation. INTERVENTION/OUTCOME Diagnosis of chylous ascites with primary intestinal lymphangiectasia made on laparotomy. MESSAGE Acute peritonitis may be a presentation of primary intestinal lymphangiectasia and chylous ascites.
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Affiliation(s)
- Aakanksha Goel
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India. Correspondence to: Dr Aakanksha Goel, House No 1 Sukh Vihar, Delhi 110 051, India.
| | - Manish Kumar Gaur
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Pankaj Kumar Garg
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
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Ghelfi J, Perolat R, Cheuret J, Fontaine E, Boatta E, Thony F, Sengel C, Delouche A, Ferretti G, Michy T. Is There a Place for Repeat Lymphangiography in Postoperative Chylous Ascites? Cardiovasc Intervent Radiol 2018; 41:1633-1635. [PMID: 29931386 DOI: 10.1007/s00270-018-1994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/19/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Julien Ghelfi
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France.
| | - Romain Perolat
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| | - Julie Cheuret
- Clinique universitaire de gynécologie-obstétrique, CHU de Grenoble, La Tronche, France
| | - Eric Fontaine
- Responsable du Centre Agréé de Nutrition Parentérale à Domicile, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| | - Emanuele Boatta
- Unité d'imagerie interventionnelle, CHU de Strasbourg, 67000, Strasbourg, France
| | - Frederic Thony
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| | - Christian Sengel
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| | - Aurelie Delouche
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| | - Gilbert Ferretti
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| | - Thierry Michy
- Clinique universitaire de gynécologie-obstétrique, CHU de Grenoble, La Tronche, France
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Held JM, Restrepo R, Ricca R. Chylous Ascites in a Neonate with Hydrops Fetalis. Am Surg 2016; 82:783-784. [PMID: 27670562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Jenny M Held
- Department of Pediatric General and Thoracic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, USA
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Ha GW, Lee MR. Surgical repair of intractable chylous ascites following laparoscopic anterior resection. World J Gastroenterol 2015; 21:6077-6081. [PMID: 26019476 PMCID: PMC4438046 DOI: 10.3748/wjg.v21.i19.6077] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/26/2015] [Accepted: 02/13/2015] [Indexed: 02/06/2023] Open
Abstract
Chylous ascites is the accumulation of a milk-like peritoneal fluid rich in triglycerides and it is an unusual complication following surgical treatment of colorectal cancer. Conservative management is usually sufficient in patients with chylous ascites after surgery. However, we describe a patient with intractable chylous ascites after laparoscopic anterior resection for sigmoid colon cancer who failed initial conservative treatment. This patient was successfully managed by surgery.
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Emınler AT, Ayyildiz T, Irak K, Dolar E. Tuberculous peritonitis case at advanced age presenting with chylous ascites. Turk J Gastroenterol 2013; 23:423-5. [PMID: 22965525 DOI: 10.4318/tjg.2012.0382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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17
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Lee HB, Lee JH, Lee MS, Jee YS, Park DJ, Kim HH. Laparoscopic management of chylous ascites caused by traumatic injury. Am Surg 2011; 77:507-509. [PMID: 21679570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Han-Byoel Lee
- Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi, Korea
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18
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Moshkivs'kyĭ HI. [The role of percutaneous interventions under the control of ultrasound examination in the treatment of postoperative fluid accumulations in suborgan space]. Klin Khir 2010:45-50. [PMID: 20862846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
There are adduced the results of transcutaneous interventions under ultrasonographic investigation guidance in 106 patients, performed for extraorgan liquid accumulations (ELA)--chylomas, haematomas and seromas. There were elaborated indications for punctures and drainage application, algorhythm of treatment was proposed, taking into account peculiarities of every pathologic condition. Efficacy of minitraumatic methods in radical treatment of ELA, which may serve as an alternative for reoperation conduction and have certain advantages over them, was proved.
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Abstract
Chylous ascites as a result of laparoscopic donor nephrectomy (LDN) is a rare complication that carries significant morbidity, including severe protein-calorie malnutrition and an associated immunocompromised state. We report a patient who underwent hand-assisted left LDN and subsequently developed chylous ascites. He failed conservative therapy including low-fat diet with medium-chain triglycerides (LFD/MCT) and oral protein supplementation as well as strict NPO status with intravenous (IV) total parenteral nutrition (TPN) and subcutaneous (SQ) somatostatin analogue administration. Laparoscopic re-exploration and intracorporeal suture ligation and clipping of leaking lymph channels successfully sealed the chyle leak. We review the literature to date including diagnosis, incidence, management options, psychosocial aspects and clinical outcomes of chylous ascites after LDN.
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Affiliation(s)
- J Aerts
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
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20
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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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21
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Olivar Roldán J, Fernández Martínez A, Martínez Sancho E, Díaz Gómez J, Martín Borge V, Gómez Candela C. [Postsurgical chylous ascites: case report and literature review]. NUTR HOSP 2009; 24:748-750. [PMID: 20049381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Accepted: 05/11/2009] [Indexed: 05/28/2023] Open
Abstract
Chylous ascites derives from chyle leakage into the peritoneal cavity, either due to rupture or obstruction of abdominal lymphatic vessels. The main clinical sign is abdominal distention, while diagnosis requires the presence of triglycerides in ascitic fluid. Neoplasms are the most common cause of chylous ascites, although less common causes, such as abdominal surgery, should also be considered. The mainstay of therapy is hyperproteic diet with fat restriction and middle-chain triglycerides. Parenteral nutrition is reserved for cases in which dietary treatment fails to restore an optimal nutritional status or is contraindicated, whereas surgery is considered for patients that are deemed refractory to conservative therapy. We present a case of chylous ascites secondary to retroperitoneal lymphadenectomy.
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Affiliation(s)
- J Olivar Roldán
- Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, España.
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22
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Bouwman LH, Wiendels DR, Rebergen SA, Guicherit OR. [Chylous ascites]. Ned Tijdschr Geneeskd 2009; 153:932-936. [PMID: 19489300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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23
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Bouwman LH, Wiendels DR, Rebergen SA, Guicherit OR. [Chylous ascites]. Ned Tijdschr Geneeskd 2009; 153:B92. [PMID: 20051146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 49-year-old female presented in a casualty department with acute abdomen. The CT scan revealed an extensive build-up of peritoneal and retroperitoneal fluid. Laparotomy revealed chylous ascites in the abdominal cavity. The patient made a successful recovery following treatment with total parenteral nutrition. No cause of the chylous ascites was found. Extensive diagnostics are indicated in adults with chylous ascites without a history of surgery as the most common cause of the condition in this group is malignant lymphoma. Treatment is targeted at a good nutritional status, lowering chylous production and treating the underlying causes.
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Affiliation(s)
- Lee H Bouwman
- Ziekenhuis Bronovo, Afd. Chirurgie, Den Haag, The Netherlands.
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24
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Onnitsev IE, Khokhlov AV. [Surgical treatment of chyloperitoneum]. Vestn Khir Im I I Grek 2009; 168:44-47. [PMID: 19663279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The investigation is based on 260 observations of patients with ascitis. According to the character of ascitis the patients were distributed as follows: chyloperitoneum--in 19 patients, serous ascitis--in 210, lymphatic--in 4, ascitis-peritonitis--in 27 patients. Milky colour of the liquid, content of chylomicrons more than 13.5%, triglycerides more that 2.5 mmol/l and lymphocytes more than 78% of the total number of the cells are considered the diagnostic signs of chyloperitoneum. The causes of chyloperitoneum might be the formation of an intraperitoneal lymphatic fistula against the background of congenital defects of the lymphatic system, rupture of the lymphatic cyst, as well as an infectious and inflammatory process in lymph nodes, vessels. Favorable surgical treatment of chyloperitoneum depends on timely diagnosing and detection of the source of its formation. Surgical strategy of treatment of chyloperitoneum patients must be selective and consider the leading pathogenetic factors and the severity of the patient's state. Most effective measures are suturing the lymphatic fistula, lymphatic cyst excision, elimination of lymphatic and portal hypertension, correction of the albuminous composition of blood.
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25
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Makino Y, Shimanuki Y, Fujiwara N, Morio Y, Sato K, Yoshimoto J, Gunji Y, Suzuki T, Sasaki SI, Iwase A, Kawasaki S, Takahashi K, Seyama K. Peritoneovenous shunting for intractable chylous ascites complicated with lymphangioleiomyomatosis. Intern Med 2008; 47:281-5. [PMID: 18277030 DOI: 10.2169/internalmedicine.47.0475] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 38-year-old woman was admitted due to lymphangioleiomyomatosis (LAM)-associated massive chylous ascites and progressive cachexia. She was incidentally diagnosed to have ascites during her regular physical check-up two years previously and LAM was revealed as its underlying cause. Periodic paracentesis was required to ameliorate ascites-associated symptoms, but resulted in lymphocytopenia, malnutrition, and deterioration of general status. Ascites was refractory to diuretics and fat-restricted diet. Peritoneovenous shunt (Denver shunt) was placed and thereafter ascites has been managed successfully without any complications for one year after the placement. Peritoneovenous shunt should be considered in LAM patients whose chylous ascites can not be managed with conservative treatments.
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Affiliation(s)
- Yuko Makino
- Department of Respiratory Medicine, Juntendo University, School of Medicine, Tokyo, Japan
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26
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Abstract
A 3-year-old girl with recurrent chylous ascites was successfully treated by laparoscopic ligation of the ruptured lymphatic trunk. She was referred to our hospital at 16 days of age because of marked abdominal distension. Imaging methods showed massive ascites of unknown origin, and analysis of the ascites revealed its chylous nature. Conservative treatments were started. Her condition improved to some extent, and she was discharged. Two years later, she was readmitted with abdominal distension and loss of appetite. Laparoscopic surgery was planned to clarify the etiology and to treat intractable ascites. Sudan black B was orally administered, and laparoscopy revealed the presence of a whitish-gray fluid in the abdominal cavity, and a dark-blue stream of the dye was noticed. The responsible lesion of the chylous ascites was detected by tracking the stream. The lesion was ligated twice with an endoloop. She has been completely free from the symptoms for 3 years and 9 months. This experience indicates the usefulness of laparoscopic surgery in investigating the etiology of chylous ascites and treating it. The concomitant use of a lipophilic dye is mandatory to find the responsible lesion at surgery. Laparoscopic surgery, instead of open surgery, should be considered as a treatment of choice for intractable chylous ascites.
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Affiliation(s)
- Minoru Kuroiwa
- Department of Surgery, Gunma Children's Medical Center, Shibukawa, Gunma 377-8577, Japan.
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27
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Onnitsev IE. [Pathogenesis, diagnostics and treatment of chyloperitoneum]. Vestn Khir Im I I Grek 2007; 166:82-86. [PMID: 18050651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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28
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Boccardo F, Bellini C, Eretta C, Pertile D, Da Rin E, Benatti E, Campisi M, Talamo G, Macciò A, Campisi C, Bonioli E, Campisi C. The lymphatics in the pathophysiology of thoracic and abdominal surgical pathology: Immunological consequences and the unexpected role of microsurgery. Microsurgery 2007; 27:339-45. [PMID: 17477428 DOI: 10.1002/micr.20347] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The authors report their experience in the diagnosis and treatment of lymphatic and chylous disorders in the thoracic and abdominal areas. Sixteen patients (10 adults, 6 children) affected by primary chylous ascites with associated syndromes and consequent immunological incompetence were studied. Diagnostic investigations included abdominal sonography scans, lymphoscintigraphy, and lymphography combined with computed tomography and laparoscopy. Surgical treatment included laparoscopy, drainage of ascites and/or the chylothorax, treatment of abdominal and retroperitoneal chylous leaks, exeresis of lymphodysplastic tissues, ligation of incompetent lymph vessels also by CO(2) LASER, and chylo-venous and lympho-venous microsurgical shunts. Eleven patients did not have a relapse of the ascites and four patients had a persistence of a small quantity of ascites with no protein imbalance. All patients had an improvement of their immunocompetence. Median follow-up was 5 years. We demonstrated that the use of microsurgery is remarkably advantageous for performing a causal treatment of the dysfunction.
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Affiliation(s)
- Francesco Boccardo
- Department of Surgery, Unit of Lymphatic Surgery and Microsurgery, San Martino Hospital, University of Genoa, Genoa, Italy.
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29
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Abstract
A 44-year-old woman developed chylous ascites following laparoscopic transperitoneal left radical nephrectomy with para-aortic lymph node dissection. Because conservative managements failed to stop the lymphatic leakage, laparoscopic lymphostasis was performed. Drinking milk 6 h prior to the operation enabled visualization of chylous ascites. Although a definite fistula was hard to identify, most of the chylous leak disappeared after ligation of the para-aortic tissues at the distal and proximal ends of the previous lymph node dissection. Laparoscopic ligation of the para-aortic bundle of lymph ducts was effective in managing long-standing postoperative chylous ascites.
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Affiliation(s)
- Koji Nishizawa
- Kyoto University Hospital, Department of Urology, Kyoto, Japan.
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30
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Affiliation(s)
- Hector F Simosa
- Department of Surgery, Boston University School of Medicine and the Trauma Center, Boston Medical Center, Boston, Massachusetts 02118, USA.
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31
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Castillo OA, Litvak JP, Kerkebe M, Olivares R, Urena R. Case report: laparoscopic management of massive chylous ascites after salvage laparoscopic retroperitoneal lymph-node dissection. J Endourol 2006; 20:394-6. [PMID: 16808649 DOI: 10.1089/end.2006.20.394] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Chylous ascites is an infrequent complication of retroperitoneal surgery. We describe a patient who suffered massive chylous ascites after simultaneous pneumonectomy and laparoscopic excision of a post-chemotherapy tumor mass. After conservative management failed, exploratory laparoscopy identified the site of the leak, which was clipped and closed with fibrin glue. There has been no recurrence in the ensuing 5 years.
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Affiliation(s)
- Octavio A Castillo
- Section of Endourology and Laparoscopic Urology, Clinica Santa Maria, Santiago, Chile.
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32
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33
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Campisi C, Bellini C, Eretta C, Zilli A, da Rin E, Davini D, Bonioli E, Boccardo F. Diagnosis and management of primary chylous ascites. J Vasc Surg 2006; 43:1244-8. [PMID: 16765248 DOI: 10.1016/j.jvs.2005.11.064] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Accepted: 11/21/2005] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chylous ascites is the accumulation of triglyceride-rich, free, milk-like peritoneal fluid caused by the presence of intestinal lymph in the abdominal cavity. Primary chylous ascites is uncommon. We present our experience in the diagnosis and treatment of this condition. METHODS Twelve patients (7 adults, 5 children) affected by primary chylous ascites were studied. Diagnostic investigations included abdominal sonography scans, lymphoscintigraphy, and lymphography combined with computed tomography (CT) with intravenous and intralymphatic lipid-soluble contrast, and laparoscopy. Magnetic resonance imaging was used when lymphography and lymphatic CT were not able to define the dysplasia well, or in the presence of lymphatic dilatation. Surgical treatment included laparoscopy (12/12), drainage of ascites (12/12), the search for and treatment of abdominal and retroperitoneal chylous leaks (12/12), exeresis of lymphodysplastic tissues (12/12), ligation of incompetent lymph vessels (9/12), carbon dioxide laser treatment (cut and welding effects) of the dilated lymph vessels using an operating microscope for magnification (9/12), and chylovenous and lymphovenous microsurgical shunts (7/12). RESULTS Eight patients did not have a relapse of the ascites, and three patients had a persistence of a small quantity of ascites with no protein imbalance. Postoperative lymphoscintigraphy in seven patients confirmed better lymph flow and less lymph reflux. Median follow-up was 5 years (range, 3 to 7 years). We observed early relapse of chylous ascites in only one case that required a peritoneal-jugular shunt and led to good outcome. CONCLUSION Primary chylous ascites is closely correlated to lymphatic-lymphonodal dysplasia that does not involve a single visceral district alone. Medical preoperative treatment played an essential role in the global management of this complex pathology. We demonstrated that the use of laparoscopy is remarkably advantageous for confirming diagnosis, for draining the ascites, and for evaluating the extension of the dysplasia. Our diagnostic work-up provided us with an exact diagnostic assessment and allowed us to plan a precise surgical approach.
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Affiliation(s)
- Corradino Campisi
- Department of Surgery, Lymphatic Surgery and Microsurgery Unit, S. Martino Hospital, University of Genoa, Genoa, Italy
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Abstract
Intractable post-operative chylous ascites had been managed successfully using a peritoneovenous shunt (PVshunt). A 4-year-old girl with neuroblastoma originated from the right adrenal gland was admitted to our hospital. Following the preoperative chemotherapy, tumor resection, and lymph node dissection of the abdominal paraaortic region were carried out. Post-operative radiation therapy 9.6 gray to the tumor bed and to the paraaortic region and a high dose chemotherapy supported by auto bone marrow transplantation were completed. Three months later some enlarged lymph nodes along the duodeno-hepatic ligament were detected and these had gradually increased in size. Lymph node dissection along the hepatic artery and the abdominal aorta was carried out. Pathological examination of the specimen showed reactive lymph node swelling. Chylous ascites developed several days after surgery. Despite the medium-chain triglycerides meal or total parental nutrition, the ascites persisted for more than 80 days. Multiple paracenteses were mandatory. A PV shunt was implanted and the ascites was resolved by the fourth post-operative day. Thirty months later, the vascular end tube of the shunt was ligated. As ascites had not accumulated for 2 weeks, the PV shunt was removed. The patient has been doing well without recurrence of ascites or neuroblastoma for 12 years. As PV shunts were mostly used for long lasting disease, it has not been referred as to how to know when the shunt should be removed. If the shunt is inserted for transient management of ascites, less invasive methods of investigation to know when to remove the shunt need to be developed.
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Affiliation(s)
- Hiroshi Matsufuji
- Department of Pediatric Surgery, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, 104-8560 Tokyo, Japan.
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35
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Dissanaike S, Griswold JA, Halldorsson A, Frezza EE. Isolated chyle duct injury in blunt trauma. Am Surg 2006; 72:116-7. [PMID: 16536238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
We present a case of a patient sustaining an isolated injury to the right main branch of the cysterna chyli due to a high-speed motor vehicle accident. A 42-year-old man presented after a high-speed collision. CT revealed a collection of hypodense fluid in the gallbladder fossa, which was the clue to take him to the OR. We proceeded to laparoscopic exploration, and based on the milky white color of the fluid, identified a chyle leak. In an open fashion, the retroperitoneum was explored and the injury was identified as disruption of the right lumbar branch entering the cisterna chyli, and this was ligated with silk ties. Chyle duct injury secondary to blunt trauma is a rare finding. The use of CT imaging can identify this injury. Laparoscopy can confirm the injury. Open ligation of the injured duct is the best treatment.
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Affiliation(s)
- Sharmila Dissanaike
- Division of General Surgery, Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas 79415, USA
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36
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Jensen EH, Weiss CA. Management of chylous ascites after laparoscopic cholecystectomy using minimally invasive techniques: a case report and literature review. Am Surg 2006; 72:60-3. [PMID: 16494185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Chylous ascites is a rare complication after many abdominal procedures. It has never been reported after laparoscopic cholecystectomy. We describe a 31-year-old female who presented 2 weeks postoperatively after laparoscopic cholecystectomy with abdominal distention and pain. A percutaneously drained abdominal fluid collection revealed chylous ascites. Lymphoscintigraphy demonstrated extravasation at the level of the hepatic fossa. At laparoscopic exploration, a chylous leak within the gallbladder fossa was controlled with suture ligation and fibrin glue with immediate resolution of the leak. This demonstrates a novel, minimally invasive technique for control of a previously unreported complication after laparoscopic cholecystectomy.
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Affiliation(s)
- Eric H Jensen
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
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37
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Haraguchi M, Kuroki T, Tsuneoka N, Furui J, Kanematsu T. Management of chylous leakage after axillary lymph node dissection in a patient undergoing breast surgery. Breast 2005; 15:677-9. [PMID: 16364645 DOI: 10.1016/j.breast.2005.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Revised: 10/24/2005] [Accepted: 11/09/2005] [Indexed: 11/30/2022] Open
Abstract
A 71-year old woman who underwent a modified radical mastectomy for invasive ductal carcinoma of the left breast, developed postoperative chylous leakage. Though conservative management was uneffective, a direct surgical repair led to good results. Because the morbidity of a reoperation to the superficial chest wall is low, timely surgical treatment is therefore strongly recommended in cases of high output chylous leakage following a mastectomy.
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38
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Dewdney S, Sokoloff M, Yamada SD. Conservative management of chylous ascites after removal of a symptomatic growing retroperitoneal teratoma. Gynecol Oncol 2005; 100:608-11. [PMID: 16226796 DOI: 10.1016/j.ygyno.2005.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 08/29/2005] [Accepted: 09/03/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND Chylous ascites as a postoperative complication of gynecologic surgery is uncommon. Cases usually occur from trauma to the lymphatic system during retroperitoneal dissection. Initial management includes paracentesis with institution of a low-fat, medium-chain triglyceride diet and total parenteral nutrition (TPN). Surgical intervention may be required. CASE A 19-year-old female patient with a history of an immature teratoma treated with chemotherapy presented with a retroperitoneal mass. Removal of the mass revealed mature teratoma and resulted in chylous ascites formation. Multiple paracenteses were performed in conjunction with dietary modification and TPN. Three months after the patient's surgery, the ascites spontaneously resolved. CONCLUSION Although surgical intervention is recommended after failure of conservative management, this case demonstrates that damage to the cisterna chyli may spontaneously resolve.
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Affiliation(s)
- S Dewdney
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, 5841 South Maryland Avenue, MC 2050, Chicago, IL 60637, USA
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39
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Abstract
Chylous ascites is uncommon and occurs in about 1 in 20,000 hospital admissions. Causes include disruption of the lymphatic system due to malignancy, cirrhosis, surgery, or radiation therapy. The mainstay of therapy has been low-fat diet supplemented with medium-chain triglyceride oil. However, dietary compliance can be difficult to achieve for adequate response. We report a 47-year-old man with hepatitis C and alcohol-related cirrhosis with new-onset chylous ascites and chylothorax. His ascites triglyceride was 585 mg/dL, and the pleural fluid triglyceride was 691 mg/dL. Ascitic and pleural fluid cytology and acid-fast bacilli stain were negative. The patient was treated with low-fat diet and medium-chain triglyceride oil. However, his ascites remained chylous after 1 week of treatment because of poor compliance with the dietary restrictions. Orlistat was then added to his treatment regimen. A half week later, the chylous component of his ascites resolved. Remaining high-volume clear ascites was treated with placement of a transjugular intrahepatic portosystemic shunt. To our knowledge, orlistat has never been used in the treatment of chylous ascites. This case suggests the potential value of adding orlistat to low-fat diet and medium-chain triglyceride oil in the treatment of chylous ascites, especially in patients who are unable to comply with the dietary restrictions.
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Affiliation(s)
- Jaime Chen
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of California, San Diego, CA 92161, USA
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40
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Abstract
We describe a patient with chylous ascites, who was extensively investigated for the cause. No malignant or lymphatic disease could be found, but a liver biopsy revealed liver cirrhosis. The chylous ascites was unsuccessfully treated with a sodium restriction diet, diuretics and a medium chain triglyceride diet. After the placement of a transjugular intrahepatic portosystemic shunt the ascites disappeared.
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Affiliation(s)
- G J de Vries
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Maastricht, The Netherlands
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41
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Reshetnikov EA, Mironov AS, Malov II. [Diagnosis and differential treatment of acute pancreatitis of biliary etiology]. Khirurgiia (Mosk) 2005:25-7. [PMID: 16352989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The experience in examination and treatment of 208 patients with acute pancreatitis of biliary etiology was analyzed. Complex endoscopic treatment was carried out in 88% patients. If there are indications, it is reasonable to perform retrograde pancreatocholangiography (RPCG) and endoscopic papillosphincterotomy (EPST) during surgery in patients with concomitant enzymatic ascites-peritonitis. In the others patients RPCG and EPST must be regarded as the first stage of treatment. Surgical procedure of choice at the second stage of treatment is laparoscopic cholecystectomy.
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42
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Abstract
BACKGROUND Chylous ascites is an uncommon complication following para-aortic lymph node dissection in the management of gynecologic malignancies. Treatment options are serial paracentesis, medium-chain triglyceride diet, total parenteral nutrition and somatostatin as conservative management and peritoneovenous shunting, and surgical exploration for refractory cases. CASE A 31-year-old female patient developed chylous ascites following para-aortic lymph node dissection for borderline mucinous tumor of the ovary. Conservative management options failed with recurrence of chylous ascites. Chylous ascites resolved after surgical closure of the lymphatic fistula on the cisterna chyli. There was no evidence of ascites at 10 months follow-up. CONCLUSION If the patient is a good surgical candidate, surgical exploration should be considered earlier in the treatment of refractory chylous ascites.
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Affiliation(s)
- Nurettin Boran
- Department of Gynecologic Oncology, SSK Ankara Maternity and Women's Health Teaching Hospital, Etlik, Ankara, Turkey
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43
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Kinney TB, Ferrara SL, Miller FJ, Roberts AC, Hassanein T. Transjugular intrahepatic portosystemic shunt creation as treatment for refractory chylous ascites and chylothorax in a patient with cirrhosis. J Vasc Interv Radiol 2004; 15:85-9. [PMID: 14709693 DOI: 10.1097/01.rvi.0000106391.63463.4c] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The etiology of chylothorax is usually considered to consist of four major categories: tumors, trauma, idiopathic conditions, and miscellaneous conditions. It appears that chylothorax is a rare and underreported manifestation of cirrhosis resulting from transdiaphragmatic passage of chylous ascites. This condition can be debilitating as a result of respiratory compromise from a large volume of pleural fluid, as well as metabolic derangements, malnutrition, and immunologic impairment from loss of vital lymphatic constituents. Herein the authors present a case of a 46-year-old male patient with cirrhosis and complications of high-volume chylous ascites and chylothorax who was successfully treated with creation of a transjugular intrahepatic portosystemic shunt.
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Affiliation(s)
- Thomas B Kinney
- Department of Radiology, University of California San Diego Medical Center, 200 West Arbor Street, mail code 8756, San Diego, California 92101, USA.
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Affiliation(s)
- Brian Geary
- Division of Urology, University of Alabama School of Medicine at Birmingham, Birminghan, Alabama, USA
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Bondarenko MV. [Strategies in the surgery choice in patients with hepato-pancreatic-duodenal-biliary diseases involving cardiovascular and respiratory system diseases]. Klin Khir 2004:18-20. [PMID: 15124467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Results of treatment of 38 patients, suffering nontumoral and tumoral diseases of the hepatopancreatoduodenal zone organs and concurrent diseases of cardiovascular and respiratory systems were analyzed. Septic-purulent affections, caused by the principal disease, had constituted the leading complication in occlusion-stenotic affection of cardiac coronary vessels. Due to the alternative absence the majority of the patients were operated on with lethal outcome. Basing on analysis of morphometric investigations of cardiac vessels there was suggested the expedience of coronarographic investigation conduction and, basing on its results, to perform preoperatively the balloon dilatation or stenting of cardiac coronary vessels, independently of kind of the main disease present. In presence of haemodynamically significant stenosis of the cardiac coronary vessels trunk and main branches (more than 70% of their lumen) the lethal outcome risk after performance of operative intervention is very high.
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Riza Altiparmak M, Avsar S, Yanik S. Chylous ascites and chylothorax due to constrictive pericarditis in a patient undergoing haemodialysis. Neth J Med 2004; 62:59-61. [PMID: 15127833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Chylous ascites and chylothorax are rare clinical entities and usually caused by neoplasms, particularly lymphomas, liver cirrhosis, superior vena cava thrombosis, nephrotic syndrome, and some cardiac events such as dilated cardiomyopathy or right heart failure. Constrictive pericarditis is an extremely rare cause of this clinical state. We report a 41-year-old male patient undergoing haemodialysis who presented with chylous ascites and chylothorax. Echocardiography and heart catheterisation revealed constrictive pericarditis. He underwent pericardiectomy and after the operation the ascites and pleural effusion resolved rapidly. We suggest that constrictive pericarditis should be considered in the differential diagnosis of chylous ascites and chylothorax.
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Affiliation(s)
- M Riza Altiparmak
- Department of Internal Medicine, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.
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Abstract
INTRODUCTION Acute chylous ascites is an affection rarely encountered among acute painful abdominal syndromes. OBSERVATION An acute chylous ascites was observed in a 76 Year-old man without prior history. Its etiology was an acute pancreatitis. Intestinal occlusion on the 15th day post-surgery required adhesiolysis. DISCUSSION Intestinal occlusion is exceptional after chylous acsites despite the potential adherence of the chyle. Regarding the pathogenesis, analysis of the literature and our case report suggest either a bridle, adherences, or a peri-intestinal sheath due to the organisation of the chyle at the origin of the occlusion following chyloperitonitis. CONCLUSION Although an etiology of chylous ascites can be an intestinal occlusion, it can, although rarely, also be a more or less late complication.
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Affiliation(s)
- Philippe Michel
- Service de chirurgie viscérale, Hôpital d'Instruction des Armées Legouest 27, avenue de Plantières 57998 Metz Armées
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Affiliation(s)
- Wilson R Molina
- Sectrion of Laparoscopic and Minimally Invasive Surgery, Glickman Urological Institute, A100, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Abstract
Chylous ascites in children has been treated in a variety of ways, including a low-fat diet, medium chain triglycerides, diuretics, total parental nutrition, surgical exploration, and internal peritoneo-venous shunting. The authors describe a child with persistent congenital chyloperitoneum treated successfully with the application of fibrin glue and recommend this as an effective alternative to traditional approaches.
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Affiliation(s)
- Brice Antao
- Department of Paediatric Surgery, St James's University Hospital, Leeds, England, UK
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Lin CH, Hsu RB, Wu MH, Wang JK, Wang SS, Chu SH. Orthotopic heart transplantation in a child with severe heart failure and chylous ascites. J Heart Lung Transplant 2003; 22:826-7. [PMID: 12873553 DOI: 10.1016/s1053-2498(02)01191-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
We report a case of a heart transplantation in a 12-year-old girl 9 years after extensive lung resection and adjuvant chemo- and radiotherapy for intra-thoracic embryonic rhabdomyosarcoma. She had restrictive cardiomyopathy with severe heart failure and chylous ascites. She was treated successfully with orthotopic heart transplantation and her symptoms of chylous ascites subsided gradually after transplantation. Her abdominal girth decreased from 79 cm before the transplant to 53 cm 9 months after the transplant.
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Affiliation(s)
- Cheng-Hsin Lin
- Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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