Postoperative chylous ascites after colorectal cancer surgery

Abstract

Chylous ascites after colorectal cancer surgery occurred at an incidence of 1.0%, but was significantly more frequent after surgery for tumors fed by the superior mesenteric artery and after D3 lymph node dissection. Conservative treatment was effective in all cases.

Treatment options for chylous ascites after major abdominal surgery: a systematic review

“…Therefore optimal placement of drainage tubes is a prerequisite for postoperative detection of chylous ascites. After thorough evaluation of the literature, a clinically significant postoperative chylous ascites is best defined as the appearance of milky (1, 5,6,[8][9][10][11][12][13][14][15]27), non-purulent (8,14) fluid in the abdominal cavity or in drainage tubes, with a triglyceride level >110 mg/dl (5,8,12,14,15) and a daily minimum volume of 200 ml (8,15,18). A microbiological culture and a white blood cell count are indispensable to rule out infection.…”

“…Further typical laboratory findings included a drainage fluid/ serum ratio >1.0 for triglycerides (9) and a drainage fluid/serum ratio <1.0 for cholesterol (9). A normal white blood cell count (6,8) and negative culture (9) showed absence of infection. Conventional diagnostic lymphangiography detected the location of lymphatic leakage in about 75% of cases (30, 31)…”

“…chylous ascites was mainly based on clinical parameters by a large number of authors:Concurrent with the beginning of enteral feeding(9,13,27) the appearance of milky (1,5,6,[8][9][10][11][12][13][14][15]27), non-purulent(8,14) fluid in the drainage tubes was characteristic for postoperative chylous ascites.…”

Chylous ascites after liver transplantation: Incidence and risk factors

“…Chylous ascites is defined as the accumulation of a milky or creamy, triglyceride‐rich peritoneal fluid due to the presence of intestinal lymph in the abdominal cavity 1‐4. The pathogenesis of chylous ascites formation is related to a failure of the lymphatic system, which can occur after trauma or because of an obstruction or congenital factors.…”

“…The pathogenesis of chylous ascites formation is related to a failure of the lymphatic system, which can occur after trauma or because of an obstruction or congenital factors. The most common causes of chylous ascites are congenital lymphatic abnormalities, various infections, malignant neoplasms, blunt abdominal trauma, cirrhosis, and abdominal surgeries such as aortic aneurysm repair, inferior vena cava resection, distal splenorenal shunting, and liver transplantation (LT) 1, 3, 4‐7. Chylous ascites after LT is an extremely rare complication, and there have been only a few reported cases 6, 8.…”