A Single-Center Experience With Percutaneous Interventional Management of Refractory Chylous Ascites

Abstract

Purpose: Management of chylous ascites is poorly understood with no management guidelines. We retrospectively reviewed patients treated for chylous ascites at our institution to evaluate efficacy and safety of lipiodol lymphangiography and embolization. Materials and Methods: Seven patients underwent percutaneous interventional management of chylous ascites (average age 52.5 years, 3 female, 6 post-surgical, 1 pancreatitis) from 2012. All patients underwent lipiodol inguinal lymph node injection. Adjunctive glue embolization was performed if a leak was identified. Data were collected on the cause of chylous ascites, conservative management strategies, procedural details, and success. Results: All patients had chylous ascites refractory to conservative management. Preprocedure lymphoscintigraphy identified a retroperitoneal leak in 6 patients. Seven patients underwent 12 lymphangiogram procedures; 8 were performed at our institution. Lymphangiography identified a leak in 5 patients (71%). Success was achieved in 2 patients (28%) treated at our institution after glue embolization following cannulation of the leaking lymphatic channels and 1 patient (14%) after lymphangiography alone for an overall success rate of 43% (3/7). Two patients (29%) were successfully treated after one procedure. Two patients (29%) unsuccessfully treated at our institution were referred to a specialized center in the United States. No 30 day post procedural complications. Conclusions: In our experience, lymphangiography and embolization was a safe, relatively effective and minimally invasive method for treating medically refractory chylous ascites. Complex cases required referral to a specialized institution with resources unavailable at our tertiary care center.

Nomogram for predicting chylous ascites after right colectomy

“…Pan et al [ 22 ] revealed that in treating CA, enteral nutrition (EN) + medium-chain triglyceride (MCT) instead of total parenteral nutrition (TPN) was the best nutritional support and somatostatin should be used immediately. Aalami et al [ 23 ] published a large review of 156 cases and concluded that the resolution rate of conservative treatment was 67% while the remaining 33% of patients required surgical intervention such as lymphangiography and embolization[ 24 ]. The patients with CA that we included in this study were all cured by conservative treatment, such as diet control and the administration of somatostatin or its synthetic derivatives but the hospital stay was significantly prolonged with an average length of stay of 15.7 d, leading to a significant increase in hospital costs and was not conducive to the turnover rate of hospital beds.…”

Management of refractory chylous ascites: a challenge after lymphadenectomy

“…In this scenario, a feasible alternative is percutaneous interventional management. 7 Although the indications for this approach are varied, some authors have proposed its use with drainage of 1000 mL/day for 45 days or persistent drainage lasting more than 1–2 weeks despite conservative treatment. 8 Fewer than 100 cases have been described in the literature.…”

“…Different authors have reported success rates with lymphangiography and embolization between 35–86%, without significant minor or major complications. 7 9 Even performing repeat procedures, clinical success is achieved in up to 86% of cases, without adverse events. 9 Complications following lymphangiography are rare.…”

“…8 Fewer than 100 cases have been described in the literature. 7 Different authors have reported success rates with lymphangiography and embolization between 35-86%, without significant minor or major complications. 7 9 Even performing repeat procedures, clinical success is achieved in up to 86% of cases, without Tumor board adverse events.…”

Lipiodol Lymphangiography and Embolization of Chylous Ascites After Pancreatoduodenectomy

“…Lymphangiography and percutaneous embolization are a less invasive procedure and have been reported to have a therapeutic effect in 56-86% of patients with lymphatic leaks 1,2 . Intranodal lymphatic embolization has been previously described in the treatment of some visceral lymphatic leaks 1,5,13 . This study aimed to present a case of chylous ascites after pancreatoduodenectomy treated with lipiodol lymphangiography and embolization.…”