Chylous Ascites in Advanced Gallbladder Cancer

Abstract

Chylous ascites is a very rare occurrence in a patient with gallbladder cancer (GBC), and only six cases have been reported. We report here one such case in a 55-year-old lady who presented to us with upper abdominal pain for 6 months. A polypoidal gallbladder mass with minimal liver invasion but with multiple subcentimeter pericholedochal, common hepatic, mesenteric, and para-aortic lymph nodes was found on contrast-enhanced computed tomography scan. At laparotomy, the abdomen had milky fluid with engorged beaded lymphatics all over the small intestine. The abdomen was closed over a drain after a lymph node biopsy and collection of the ascetic fluid for analysis. Histopathology confirmed metastatic adenocarcinoma in the lymph node. The triglyceride levels in the ascetic fluid were elevated to 817.00 mg/dl. The patient was put on medium-chain triglyceride diet and a diuretic and recovered well. She was discharged when drain output was nil. Chylous ascites could be a result of abdominal malignancy, post surgery, cirrhosis, and disseminated infections like tuberculosis and filariasis. Treatment is primarily conservative and includes paracentesis/drainage of the peritoneal cavity supplemented by fasting, total parenteral nutrition, and/or diet modification with medium-chain triglyceride diet.

Transanal Suture Mucopexy for Hemorrhoids

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Low-Hanging Fruit for the Environmental Plastic Surgeon: Quantifying Water Waste in Soap-Based Scrub

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“…Investigations into this ruling have concluded that it falls short of its goal of encouraging pricing competition and promoting patient choice because of a lack of hospital compliance, standardization, and CMS enforcement. 1,2 We surveyed hospitals' pricing data available for plastic surgery patients. The lack of reporting and large variability in prices for plastic surgery procedures led us to conclude that the statute is not currently a useful tool for plastic surgery patients.…”

Sushruta: The Ultimate Mentor—But What Happened to His Mentees?

“…His accomplishments include describing surgical indications and techniques in various fields of surgery. 1 As it relates to plastic surgery, his surgical expertise in the manipulation of soft tissue and rhinoplasty was unparalleled. Amputation of the nose was a common punishment in ancient India, and Sushruta described more than 15 methods of repairing various subunits of the nasal complex using local tissue based on axial blood supply as well as random pattern flaps.…”