Octreotide in the outpatient therapy of cirrhotic chylous ascites: A case report

Berzigotti, Annalisa; Magalotti, Donatella; Cocci, C.; Angeloni, L.; Pironi, Loris; Zoli, Marco

doi:10.1016/j.dld.2005.05.013

Cited by 24 publications

(27 citation statements)

References 26 publications

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“…First, there is increased lymphatic fluid production in the liver and splanchnic areas in patients with liver cirrhosis. This increase generally exceeds the capacity of the intestinal lymphatic drainage system 6, 9, 10, 13. Second, the retrohepatic lymphatic vessels and lymphatic vessels in the porta hepatis are damaged during resection of the native liver 6, 9.…”

Section: Discussionmentioning

confidence: 99%

Chylous ascites after liver transplantation: Incidence and risk factors

et al. 2012

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In this study, we evaluated the diagnosis, epidemiology, risk factors, and treatment of chylous ascites developing after liver transplantation (LT). Between 2002 and 2011, LT was performed 693 times in 631 patients at our clinic. One-hundred fifteen of these patients were excluded for reasons such as retransplantation, early postoperative mortality, and insufficient data. Chylous ascites developed after LT (mean 6 SD ¼ 8.0 6 3.2 days, range ¼ 5-17 days) in 24 of the 516 patients included in this study. Using univariate and multivariate analyses, we examined whether the following were risk factors for developing chylous ascites: age, sex, body mass index, graft-to-recipient weight ratio, Model for End-Stage Liver Disease score, vena cava cross-clamping time, total operation time, Child-Pugh classification, sodium level, portal vein thrombosis or ascites before transplantation, donor type, albumin level, and perihepatic dissection technique [LigaSure vessel sealing system (LVSS) versus conventional suture ligation]. According to a univariate analysis, a low albumin level (P ¼ 0.04), the presence of ascites before transplantation (P ¼ 0.03), and the use of LVSS for perihepatic dissection (P < 0.01) were risk factors for developing chylous ascites. According to a multivariate Cox proportional hazards model, the presence of pretransplant ascites [P ¼ 0.04, hazard ratio (HR) ¼ 2.8, 95% confidence interval (CI) ¼ 1.1-13.5] and the use of LVSS for perihepatic dissection (P ¼ 0.01, HR ¼ 5.4, 95% CI ¼ 1.5-34.4) were independent risk factors. In conclusion, the presence of preoperative ascites and the use of LVSS for perihepatic dissection are independent risk factors for the formation of chylous ascites. To our knowledge, this study is the most extensive examination of the development of chylous ascites. Nevertheless, our results should be supported by new prospective trials.

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Section: Discussionmentioning

confidence: 99%

Chylous ascites after liver transplantation: Incidence and risk factors

et al. 2012

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“…After one month, a follow-up chest X-ray revealed decreased pleural effusion and abdominal distension was also improved. Although some case reports have described the use of octreotide in the management of chylothorax or chylous ascites [14, 15, 16, 17, 18, 19], our patient improved with a regimen of anti-TB medication, diet control and supportive care; octreotide was not used.…”

Section: Discussionmentioning

confidence: 81%

Simultaneous Chylothorax and Chylous Ascites Due to Tuberculosis

2014

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Chylothorax or chylous ascites is rare manifestation of tuberculosis. We report a case of simultaneous chylothorax and chylous ascites due to tuberculosis. A 17-year-old girl was admitted with fever, abdominal distention and dyspnea. Chest and abdominal computed tomography revealed bilateral pleural effusion, multifocal nodular consolidation on both lung fields and copious ascites and multiple necrotic lymphadenopathy in the abdominal cavity. Mycobacterium tuberculosis was isolated from sputum and pleural fluid. The patient was treated with anti-tuberculosis medication. Pleural effusion and ascites improved with the medication.

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“…Lymphatic vessels of the intestine have somatostatin receptors. Octreotide, a somatostatin analog, at a dose of 100 mcg subcutaneously thrice daily is used in the management of chylous ascites[6–8]. Octreotide at 50mcg/hour decreased the ascitic drainage in our patient by 50%.…”

Section: Discussionmentioning

confidence: 82%

Chylous Ascites

Talluri

Nuthakki²,

Tadakamalla³

et al. 2011

North Am J Med Sci

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Context:Chylous ascites is the accumulation of milky chyle in the peritoneal cavity. Chylous ascites has been reported after surgeries like abdominal aortic aneurysm repair, radical gastrectomy, duodenectomy, nephrectomy and Wilm's tumor resection. Our literature search did not reveal any reports of chylous ascites after a gastric ulcer resection. We report about an elderly woman with a rare complication of chylous ascites after an emergent surgery for a perforated gastric ulcer.Case Report:A 70-year-old woman developed sudden respiratory distress on 5th post-operative day after an elective C3-C7 cervical discectomy and fusion. Her past medical history was significant for cervical spondylosis. The Computed Tomography (CT) scan of the chest revealed air under the diaphragm suspicious for hollow viscus perforation. She underwent an emergent surgery for drainage of hematoma in the neck along with an emergent laparotomy to repair a large perforated gastric ulcer distal to the gastro-esophageal junction. The patient had worsening of abdominal distention on 4th post-operative day. The CT scan of abdomen showed fluid collection in the abdomen. The abdominal drain revealed large amount of serous milky fluid at the rate of 1500 ml per day. The fluid analysis showed that the triglyceride level was 170 mg/dl and cholesterol level was 15 mg/dl. The fluid cultures did not grow any organism. She responded to treatment with octreotide and a diet of medium chain triglyceride oil.Conclusion:Any obstruction or damage to the lymphatic channels results in chylous ascites. Lymphomas, metastatic malignancies, and abdominal surgeries commonly cause chylous ascites. Ascitic fluid triglyceride level greater than 110 mg/dl is diagnostic of chylous ascites. Chylous ascites is a rare complication of a peptic ulcer resection which can be managed effectively with octreotide.

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Octreotide in the outpatient therapy of cirrhotic chylous ascites: A case report

Cited by 24 publications

References 26 publications

Chylous ascites after liver transplantation: Incidence and risk factors

Chylous ascites after liver transplantation: Incidence and risk factors

Simultaneous Chylothorax and Chylous Ascites Due to Tuberculosis

Chylous Ascites

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