Chylous ascites associated with intestinal obstruction from volvulus due to Petersen’s hernia: report of a case

Akama, Yuichi; Shimizu, Tetsuya; Fujita, Itsuo; Kanazawa, Yoshikazu; Kakinuma, Daisuke; Kanno, Hitoshi; Yamagishi, Aya; Arai, Hiroki; Uchida, Eiji

doi:10.1186/s40792-016-0207-9

Cited by 12 publications

(11 citation statements)

References 24 publications

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“…identified eight cases of CA associated with a SBO, all who underwent surgical intervention. All cases demonstrated bowel viability without the need for an enterectomy during surgery supporting the hypothesis that CA is an indicator of intestinal viability [ 8–11 ]. Clinical presentation includes abdominal distension with or without pain, nausea, anorexia, dyspnoea and oedema [ 1 , 2 , 4 , 5 ].…”

Section: Discussionmentioning

confidence: 60%

“…Interestingly, both cases reported intestinal viability intra-operatively with no resection required. Furthermore, both studies hypothesized that CA associated with SBO may be an indication of intestinal viability, as veins and lymphatics operate at a lower pressure system and are the first to be occluded during a bowel obstruction, while arterial supply is required for lymphatic production and CA accumulation [ 8 , 9 ]. In addition, Akama et al .…”

Section: Discussionmentioning

confidence: 99%

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Chylous ascites as a marker for intestinal viability in a small bowel obstruction: a case report

Morosin

Robles

2021

Journal of Surgical Case Reports

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Chylous ascites (CA) is the uncommon extravasation of triglyceride-rich fluid into the abdominal cavity as a result of the disruption of the abdominal lymphatic system. A patient who had previously undergone a subtotal colectomy presented with a closed-loop small bowel obstruction (SBO), underwent an emergency laparotomy with adhesiolysis and had intra-operative findings of milky intra-abdominal free fluid confirmed on analysis as CA. His post-operative period was complicated by a prolonged ileus, and following resolution, he was subsequently discharged home. Here, we present a case of a closed-loop SBO in which CA may be an indicator of intestinal viability.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Chylous ascites as a marker for intestinal viability in a small bowel obstruction: a case report

Morosin

Robles

2021

Journal of Surgical Case Reports

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“…However, coexistence of chylous ascites and intestinal obstruction is rare, with only few case reports are published to date [2]. Among such studies, Akama et al [2] reported that chylous ascites indicates intestinal viability because when the literature was reviewed, it was observed that intestinal resection was not required when chylous ascites was found intraoperatively. The indication of intestinal viability by chylous ascites can be explained hypothetically as follows.…”

Section: Discussionmentioning

confidence: 99%

“…Chylous ascites (milky ascites) is defined as an intraperitoneal accumulation of lymphatic fluid rich in triglycerides derived from the intraabdominal lymphatic system [1]. While the frequent causes of chylous ascites are due to the abdominal malignancy and traumatic (including surgical) damage to the lymphatic system, it is occasionally observed during surgery for intestinal obstruction, mainly small intestinal volvulus [2].…”

Section: Introductionmentioning

confidence: 99%

Chylous Ascites Accompanying Internal Hernia after Total Gastrectomy with Roux-en-Y Reconstruction

Koyama

Maeda

Minagawa

et al. 2019

Case Rep Gastroenterol

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We report the case of a 69-year-old man with a history of esophagogastric junction cancer (Barrett's esophageal cancer; pT1b [SM], N0, M0, pStage IA) that was surgically resected 2 years prior to the present episode. Recurrence was not observed during follow-up. Following complaints of dysphagia and abdominal pain, computed tomography revealed signs of internal hernia. Thus, laparoscopic exploration was performed. Intraoperatively, accumulation of chylous ascites accompanying the internal hernia through the jejunojejunostomy mesenteric defect was observed, which was successfully treated with laparoscopic hernia reduction and defect closure by sutures without intestinal resection. Here, we discuss the case and report that along with previous studies, our study suggests that chylous ascites might be a reliable sign of intestinal viability for herniated intestines.

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“…However, there is a dearth of published literature regarding chylous ascites, consisting only of case reports [5,[8][9][10][11][12]. We therefore aimed to characterize the frequency, associated conditions, and postoperative outcomes of chylous ascites in general surgery patients.…”

Section: Introductionmentioning

confidence: 99%

Chylous ascites in the setting of internal hernia: a reassuring sign

et al. 2021

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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. MethodsData 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. ResultsFifty-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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Chylous ascites associated with intestinal obstruction from volvulus due to Petersen’s hernia: report of a case

Cited by 12 publications

References 24 publications

Chylous ascites as a marker for intestinal viability in a small bowel obstruction: a case report

Chylous ascites as a marker for intestinal viability in a small bowel obstruction: a case report

Chylous Ascites Accompanying Internal Hernia after Total Gastrectomy with Roux-en-Y Reconstruction

Chylous ascites in the setting of internal hernia: a reassuring sign

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