Diagnosis and management of primary chylous ascites

Abstract

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.

Refractory Chylous Ascites

“…Preparation included a fat-rich diet and a lipophilic dye to depict lymphatic anatomy (8,9). Surgery main findings were a lymphatic leak and dilated vessels; therefore, the most probable diagnosis is a primary chylous disorder.…”

“…They can be accompanied with obstruction, agenesis, hypoplasia, disruption or dysplasias (5,8). Less frequent causes include the Yellow nail syndrome and Lymphangioleiomyomatosis (1,2).…”

“…During the first surgery, primary closure of lymphatic leak was attempted (9). Success for this therapy has been described in about 80% of cases (8), but chylocolporrhea demonstrated that the problem persisted. A multidisciplinary team discussed the remaining therapeutic alternatives, and a second surgical approach was planned.…”

Chylous Ascites Following Open Abdominal Aortic Aneurysm Repair: An Unusual Complication

“…To this end, a lymphangiogram or lymphoscintigraphy prior to surgery are useful tools. Administration of 60 g of butter 4 hours before surgery may also be useful since it increases flow of the milky fluid, making it easier to localize the leakage 13 ; failure to localize the site of injury leads to treatment failure. Surgical treatment includes suture ligation of all leaking lymph channels.…”

Congenital Chylous Ascites and Lymphedema in Down’s Syndrome: Correspondence

“…Hence to label a given case as primary chylous ascites andto distinguish it from primary intestinal lymphangiectasia one needs to assess lymphatic system with either lymphoscintigraphy or lymphangiography and perform small bowel evaluation by upper gastrointestinal endoscopy with duodenal biopsy [5]. In few studies surgical exploration has also been resorted to search and treat abdominal and retroperitoneal chylous leaks and exeresis of lymphodysplastic tissues where initial investigation did not yield the site of leak or were refractory to medical treatment in such cases [6,7]. It would have been appreciated if authors had also mentioned if at the last follow up of the child at 6 mo serum albumin was normalised or not and whether any albumin infusions were required while managing the case.…”