Chylous ascites treated by traditional Chinese herbal medicine: A case report and discussion

Xiu, Lijuan; Yan, Bing; Qin, Zhifeng; Li, Xuan; Feng, Weiwei; Wang, Xiaowei; Wei, Pin-Kang

doi:10.1016/j.ctim.2014.10.006

Cited by 3 publications

(7 citation statements)

References 17 publications

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“…Compression of vital structures may often happen in chylous ascites, lymphocele and chylothorax [ 22 ]. The others are less mentioned or with no clinical symptom, such as dehydration, nutritional deficiency, hypoalbuminemia, immunologic dysfunction or pyemia [ 22 , 83 ]. Theoretically, all of these complications can occur for a long time and a large loss of lymphatic fluid.…”

Section: Resultsmentioning

confidence: 99%

“…And lymphatic fluid can be absorbed by the peritoneum [ 99 ]. Conservative therapy including ① diet control (high protein, low fat, medium-chain triglyceride diet), the fasting and total parenteral nutrition; ② application of drugs (somatostatin analogue, vasoconstrictor pancreatic lipase inhibitor, diuretics, traditional Chinese herb medicine [ 6 , 83 ]); ③ paracentesis and sclerotherapy [ 22 ], pressure dressing.…”

Section: Resultsmentioning

confidence: 99%

“…These treatments lead an especially MCT diet for decreasing the bowel absorption of fat. It is the basic theory of lymphatic leakage treatment [ 38 , 62 , 83 , 89 ]. Leibovitch et al suggest us that MCT diet should be tried before total parenteral nutrition [ 59 ].…”

Section: Resultsmentioning

confidence: 99%

“…Another mentioned conservative treatment is traditional Chinese herb medicine (TCHM) reported by Xiu et al [ 83 ]. It is an effective way to cure lymphatic leakage, with a marked decrease for 1 day after the use of TCHM to all their 6 patients.…”

Section: Resultsmentioning

confidence: 99%

“…Most of operations are taken following the failure of conservative treatment [ 60 ]. The surgery is particularly recommended when ① leakage sustains for more than 2 weeks; ② drainage volume reaches more than 1 Liter, even after 1 week; ③ the patient starts to experience metabolic complications [ 83 ].…”

Section: Resultsmentioning

confidence: 99%

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A review of the postoperative lymphatic leakage

et al. 2017

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Lymphatic complications are rare, but well-known phenomena, and have been described by many researchers. However, many diagnoses of lymphatic complications are found confusing due to different definition. A literature search in Pubmed was performed for studies postoperative lympatic complications. These complications divided into two parts: lymphatic leakage and lymphatic stasis. This review is about lymphatic leakage, especially, postoperative lymphatic leakage due to the injury of lymphatic channels in surgical procedures. According to polytrophic consequences, many types of postoperative lymphatic leakage have been presented, including lymph ascites, lymphocele, lymphorrhea, lymphatic fistula, chylous ascites, chylothorax, chyloretroperitoneum and chylorrhea. In this review, we focus on the definition, incidence and treatment about most of these forms of lymphatic complications to depict a comprehensive view of postoperative lymphatic leakage. We hold the idea that the method of treatment should be individual and personal according to manifestation and tolerance of patient. Meanwhile, conservative treatment is suitable and should be considered first.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

A review of the postoperative lymphatic leakage

et al. 2017

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Management of intractable post‐adrenalectomy chylous ascites with microsurgical intra‐abdominal lymphaticovenous anastomosis: A case report and literature review

Chu

Hsieh

et al. 2021

Microsurgery

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Postoperative chylous ascites is a rare but highly morbid complication following thoracic or abdominal surgeries. Treatment options vary according to different clinical scenarios and facility equipment, but there is no standard guideline. We report a case of 46‐year‐old patient with chylous ascites after left laparoscopic adrenalectomy for metastatic lung cancer. The conservative treatments failed, included diet control, somatostatin provided and intranodal lymphangiography with lipiodol injection. Laparotomy was performed to explore the lymphatic vessel in the retroperitoneal area where a major and several small leaking holes were identified along the thoracic duct. The left gonadal vein was explored and transposed toward the lymphatic vessel. The lymphaticovenous anastomosis (LVA) was done using side (major leaking hole) to end (gonadal vein) fashion. The chylous leakage dropped from 2000 to 200 mL per day gradually within 10 days after LVA, and the patient was discharged uneventfully 30 days after the LVA surgery. He was followed at our clinic during the first postoperative 10 months without recurrent chylous ascites. This case demonstrates that microsurgical intervention with LVA to physiologically drain the chyle can be an optimal treatment for chylous ascites. A literature review was also conducted, and strategic management is proposed.

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Successful minimal invasive treatment of chylous ascites following pancreaticoduodenectomy: A case report and review of literature

Nguyen

Luong

Cương

et al. 2021

Annals of Medicine &Amp; Surgery

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Introduction Chylous ascites is an uncommon but potentially life-threatening type of postoperative lymphatic leakage, especially following pancreaticoduodenectomy. Case presentation A 59-year-old man underwent pancreaticoduodenectomy (PD) with extended lymphadenectomy and segmental Superior Mesenteric Vein (SMV) resection for SMV-involved pancreatic ductal adenocarcinoma (PDAC). After 20th postoperative day, patient had a drain output with a milky appearance, and with a triglyceride level was 1.6 mmol/L, and the daily output volume was up to 1500 mL per day. She has been performed Conventional Lymphangiography (CLAG) to identify the broken lymphatic vessels as well as close the leakage. Following two consecutive lymphangiography, the source of chylous leakage was identified from hilar lymphatic system, and injection of Aetoxisclerol 2% into lymphatic vessels to close the leakage was performed. Partial parenteral nutrition with limited fat components or medium-chain triglyceride (MCT) was administered, and the amount of ascites decreased particularly. The drain was removed in 20th day after the second CLAG. He had no symptoms of abdominal distention after drain removal and had been discharged after 37 postoperative days (PODs). Discussion Chylous ascites is an uncommon but potentially life-threatening complication following pancreaticoduodenectomy. Portal lymphatic plexus, which was often isolated and dissected especially with extended lymphadenectomy, is potentially damaged and caused resistant chylous leakage. Newly techniques are updated and applied in diagnosis and treatment for this difficult-to-treat complication, one of them is percutaneous transhepatic Conventional Lymphangiography (CLAG). Conclusion CLAG with percutaneous transhepatic access could be effective to identify and terminate the chylous fistula from portal lymphatic plexus after pancreaticoduodenectomy.

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Chylous ascites treated by traditional Chinese herbal medicine: A case report and discussion

Cited by 3 publications

References 17 publications

A review of the postoperative lymphatic leakage

A review of the postoperative lymphatic leakage

Management of intractable post‐adrenalectomy chylous ascites with microsurgical intra‐abdominal lymphaticovenous anastomosis: A case report and literature review

Successful minimal invasive treatment of chylous ascites following pancreaticoduodenectomy: A case report and review of literature

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