The Management of Postoperative Chylous Ascites

Ohri, S K; Patel, Trushar; La, Desa; Spencer, Jessica B.

doi:10.1097/00004836-199012000-00021

Cited by 37 publications

(26 citation statements)

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“…Nonsurgical therapy includes total parenteral nutrition, used to achieve complete bowel rest, thus decreasing the rate of chyle formation. Fasting and total parenteral nutrition might allow resolution of the chylous ascites by inhibiting lymph fluid excretion through specific receptors found in the normal intestinal wall [33] . Post-intensive-care diet has the goal to decrease the rate of chyle formation by providing high-protein and low-fat food.…”

Section: Discussionmentioning

confidence: 99%

Acute Abdomen from Chylous Peritonitis: A Surgical Diagnosis

Vettoretto¹,

Odeh²,

Romessis³

et al. 2008

Eur Surg Res

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Acute accumulation of chyle in the peritoneal cavity is a rare event (less than 100 cases are described in the literature) and is to be distinguished from chylous ascites, which is characteristically chronic. It is frequently idiopathic, and diagnosis is usually made at laparotomy, whenever signs of acute peritonitis impose it. Peritoneal toilette and drainage are the only treatment required, and the prognosis is excellent. We describe the case of a 69-year-old man who underwent emergency surgery for acute peritonitis. Approximately 0.5 liters of chyle were found free in the peritoneal cavity at laparoscopic exploration, without any important underlying pathological condition apart from a blood vessel congestion in the bowel resembling angiomatosis. Laparotomic conversion, peritoneal toilette and drainage, with postoperative low-fat diet, were the pursued treatments. Two years after discharge, chemistry and clinics are normal, without evidence of associated disease or recurrence.

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Section: Discussionmentioning

confidence: 99%

Acute Abdomen from Chylous Peritonitis: A Surgical Diagnosis

Vettoretto¹,

Odeh²,

Romessis³

et al. 2008

Eur Surg Res

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“…3,10 Among nononcologic procedures, it is most commonly seen after aortic operations, accounting for 81% of cases. 11,12 This is because aortic procedures commonly involve extensive dissection in the major retroperitoneal lymphatics. Other procedures that may result in chylous ascites include operations on the inferior vena cava, portacaval shunt, and donor nephrectomy.…”

Section: δmentioning

confidence: 99%

“…Other procedures that may result in chylous ascites include operations on the inferior vena cava, portacaval shunt, and donor nephrectomy. 12,13 Atraumatic Only 21% of 614 publications reviewed by Steinmann and associates reported atraumatic causes. 14 In adults, malignancies account for up to 85% of cases of atraumatic chylous ascites.…”

Section: δmentioning

confidence: 99%

“…20 Although not proven in humans, it is possible that individuals with a paucity of these collaterals may be prone to chylous ascites. 12 In post-OLT chylous ascites, lymphatic damage at the porta hepatis and retroperitoneum are believed to be responsible. 6,21 Haberal and associates, during an exploratory laparotomy for undiagnosed acute abdomen after a pediatric OLT, found and ligated a leaking lymphatic at the root of the mesentery near the jejunojejunal anastomosis, achieving cure.…”

Section: δmentioning

confidence: 99%

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Chylous Ascites After Liver Transplant: Case Report and Review of Literature

Mukerji

Tseng

Karachristos

et al. 2013

Exp Clin Transplant

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Case: A 62-year-old man with cirrhosis, hepatitis C, and hepatocellular carcinoma, underwent a liver transplant. On day 11 after surgery, a chylous leak from a partial wound dehiscence was noted. The leak did not respond to 2 weeks of uninterrupted, fat-free clear liquid diet and 12-hour total parenteral nutrition at night. The same treatment was continued for another 6 weeks with fatty meal challenge every weekend, which he failed. He was then given a fat-free clear liquid diet, 24-hour total parenteral nutrition, and octreotide 100 μg subcutaneously every 8 hours for 14 days. A prompt response was noted. His recovery was excellent at the time of this writing (9 months' follow-up). Discussion: Eleven major cases have been reported with 9 cases being managed conservatively. Four were given a diet plus total parenteral nutrition without octreotide producing a cure in 3 to 36 days. Two cases (including ours) were given the diet and total parenteral nutrition, which failed; octreotide was then added, and these cases were cured in 2 to 4 weeks. Therefore, diet with total parenteral nutrition failed in 33.3% of the cases (2/6). In 3 cases, octreotide was used from the outset. They were all cured in ≤ 2 weeks. One case was operated on for peritonitis; chylous ascites was found and a leak was ligated. One patient with congenital lymphatic disorder underwent peritoneovenous shunting. Octreotide was not used in any of the cases of chylous ascites that were treated surgically. Conclusions:If exploratory surgery is done for any other reason, it is best to identify a chylous leak and ligate it. Otherwise, we recommend octreotide combined with a fat-free, clear liquid diet, and supplementation with medium chain triglycerides and total parenteral nutrition from the outset.

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“…Most chylous effusions respond to an initial approach with high protein and low fat diet with medium chain triglycerides by reducing the production and flow of chyle. 6 Patients with cirrhotic chylous ascites should be managed with low sodium diet and diuretics such as spironolactone. 7 Patients who do not respond to the above measures should be fasted to reduce lymph flow and started on total parenteral nutrition(TPN).…”

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confidence: 99%