Disorders of the lymphatic system of the abdomen

Patil, Aruna R; Nandikoor, Shrivalli; Marco, Joseph D.; Bhat, Rajani; Subramaniyam, Shivakumar; Mallrajapatna, G.

doi:10.1016/j.crad.2016.06.116

Cited by 12 publications

(18 citation statements)

References 25 publications

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“…Cisterna chyli (or the receptaculum chyli) is a dilated sac-like receptacle in the retroperitoneum, present at the L1–2 vertebral level and which continues as the thoracic duct cranially. 7 The thoracic duct enters the posterior mediastinum after passing through the aortic hiatus in the diaphragm. It continues between the aorta and azygous vein and at the level of T5 vertebrae it crosses over to the left to enter the superior mediastinum.…”

Section: Lymph Formation and Anatomy Of Lymphatic Channelsmentioning

confidence: 99%

Chylous Ascites: A Review of Pathogenesis, Diagnosis and Treatment

Bhardwaj

Vaziri

Gautam

et al. 2018

Journal of Clinical and Translational Hepatology

182

266

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Chylous ascites (CA) is a rare form of ascites that results from the leakage of lipid-rich lymph into the peritoneal cavity. This usually occurs due to trauma and rupture of the lymphatics or increased peritoneal lymphatic pressure secondary to obstruction. The underlying etiologies for CA have been classified as traumatic, congenital, infectious, neoplastic, postoperative, cirrhotic or cardiogenic. Since malignancy and cirrhosis account for about two-thirds of all the cases of CA in Western countries, in this article we have attempted to reclassify CA based on portal and non-portal etiologies. The diagnosis of CA is based on the distinct characteristic of the ascitic fluid which includes a milky appearance and a triglyceride level of >200 mg/dL. The management consists of identifying and treating the underlying disease process, dietary modification, and diuretics. Some studies have also supported the use of agents such as orlistat, somatostatin, octreotide and etilefrine. Paracentesis and surgical interventions in the form of transjugular intrahepatic portosystemic shunt (commonly known as TIPS), peritoneal shunt, angiography with embolization of a leaking vessel, and laparotomy remain as treatment options for cases refractory to medical management.

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Section: Lymph Formation and Anatomy Of Lymphatic Channelsmentioning

confidence: 99%

Chylous Ascites: A Review of Pathogenesis, Diagnosis and Treatment

Bhardwaj

Vaziri

Gautam

et al. 2018

Journal of Clinical and Translational Hepatology

182

266

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“…Chylomas, otherwise known as chyloceles or lymphoceles if a cyst wall can be identified, have been occasionally reported as a delayed manifestation of chyle leak after neck surgery [4][5][6]. Besides the neck, chylomas can also occur along the more proximal course of the thoracic duct from the cisterna chyli to the mediastinum [7,8]. Large chylomas can cause swellings or compressive symptoms although small ones can be occult [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Chyloma: A Manifestation of Chyle Leak Six Months After Neck Dissection

Tay¹,

Loke²,

Ng³

et al. 2021

Cureus

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Chyle leaks after a neck dissection usually manifest within the immediate postoperative period. However, masked chyle leaks may present as a chyloma months later.A 54-year-old male patient with squamous cell carcinoma of the tongue underwent bilateral neck dissection, subtotal glossectomy, anterolateral thigh flap reconstruction and postoperative radiotherapy. Intraoperatively, chyle leak was encountered in level IV of the left neck. We managed it by ligation of the thoracic duct, application of Tisseel™ sealant (Baxter Inc., Illinois, USA) and one week of prophylactic fatfree feeds. Six months later, an asymptomatic chyloma of the left neck was identified on surveillance MRI. Five weeks after the diagnosis, streptococcal infection developed within the chyloma. However, initiation of fat-free diet, serial aspiration, pressure dressing and antibiotic therapy allowed the chyloma to resolve within two weeks. Further surveillance MRI over three years showed no recurrence of the chyloma.Low-volume chyle leaks may manifest as an occult chyloma. Prophylactic measures cannot replace meticulous ligation of chylous channels in left level IV neck dissection.

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“…The underlying etiologies of chyloperitoneum have been classified as congenital, traumatic, infectious, neoplastic, postoperative, cirrhotic, or cardiogenic [3]; almost twothirds of the reported cases in developed countries are of cirrhotic origin or associated with abdominal malignancy, while, in developing countries, infectious diseases such as tuberculosis account for the majority of cases [5].…”

Section: Introductionmentioning

confidence: 99%

“…Chyloperitoneum is considered an uncommon yet severe complication during abdominal surgery [6]. It occurs most often during postoperative retroperitoneal lymph node dissection, distal splenic shunt, abdominal aortic aneurysm repair, or liver transplant [5,7], while its presentation as a complication of colorectal cancer surgery is exceptional [8].…”

Section: Introductionmentioning

confidence: 99%

Chyloperitoneum as the Initial Manifestation of Gastrointestinal Neoplasia

et al. 2021

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Chyloperitoneum is defined as the presence of lymph within the peritoneal cavity, resulting from obstruction or injury of lymph ducts, mostly at the level of the gastrointestinal tract. This can occur in the context of congenital diseases, traumas, infections, neoplasms, hepatic disease, heart disease, and postoperative complications. The most common symptoms described are abdominal distention and mild pain in a course of weeks to months, with dyspnea, peritonitis, and in a few cases weight gain is observed due to the high intra-abdominal pressure. We present a case of a 56-year-old male with no significant personal history, who has a clinical picture of approximately three months of evolution, consisting in sensation of an abdominal mass predominantly in the left hemiabdomen, associated with progressive abdominal distension, changes in intestinal habit, lower limb edema, dyspepsia, occasional postprandial emesis, and unintentional weight loss of 20 kg. In non-traumatic conditions, the most frequent cause of chylous ascites is a malignancy disease followed by cirrhosis and mycobacterial infections. Taking into consideration that adenocarcinoma is the most frequently reported histologic subtype of jejunum neoplasm, and that not all cases of lymphoma debut with chylous ascites, it can be concluded that the proportion of patients that present with this condition is exceptionally low. Chyloperitoneum is an infrequent finding, having the higher detection rate in lymphatic alterations and malignancies of gastrointestinal location, in which some of the most commonly neoplasms associated with this complication are lymphoma, neuroendocrine tumors, sarcomas, and leukemia.

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Disorders of the lymphatic system of the abdomen

Cited by 12 publications

References 25 publications

Chylous Ascites: A Review of Pathogenesis, Diagnosis and Treatment

Chylous Ascites: A Review of Pathogenesis, Diagnosis and Treatment

Chyloma: A Manifestation of Chyle Leak Six Months After Neck Dissection

Chyloperitoneum as the Initial Manifestation of Gastrointestinal Neoplasia

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