[Acute chyloperitoneum. Clinical contribution to the study of so-called idiopathic chyloperitoneum].
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Adult↗
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Management of chyloperitoneum after abdominal aortic surgery.
Chyloperitoneum is a rarely reported complication of abdominal aortic surgery. From 1981 to 1992, we treated 5 cases of chylous ascites after operations on the abdominal aorta and reviewed 22 previously published cases. There were 22 men and 5 women, with a mean age of 63.8 years (range: 27 to 93 years). Twenty cases (74.7%) occurred after abdominal aortic aneurysm resection, 5 (18.5%) after aorto-femoral bypass for occlusive disease, and 2 (6.8%) after resection of infected aortic grafts, 1 for occlusive disease and the other for infrarenal aortic aneurysm. Abdominal distention was the most common presenting symptom, occurring in 26 (96.3%) of 27 patients. The mean time from aortic operation to the development of symptoms was 18.5 days (range: 7 to 120 days). Diagnosis was confirmed by paracentesis, which yielded lipemic, sterile fluid in all patients. Therapeutic paracentesis was not successful when used alone, but, when combined with a medium-chain triglyceride (MCT) diet or total parenteral nutrition (TPN), it resulted in resolution of chyloperitoneum in 8 of 14 patients (57.2%). TPN alone or with paracenteses and/or diuretics was successful in 9 of 15 (60%) patients. Peritoneovenous shunts resolved chylous ascites in four of five patients not responding to diet and/or TPN but resulted in one death due to sepsis. Operative ligation of the injured lymphatic channel was successful in all five patients treated by laparotomy when nonoperative efforts failed. Chyloperitoneum resolved in all but two (7.7%) patients. There were five (18.5%) deaths, but only three (11.5%) were directly related to chylous ascites. Treatment with TPN resolved chyloperitoneum in all five of our own patients. We reached the following conclusions: (1) Chyloperitoneum is a rare complication of aortic surgery; (2) This disorder should be considered whenever persistent abdominal distention appears after aortic surgery; (3) The diagnosis is easily confirmed by paracentesis; and (4) Surgery to close the lymph fistula should be reserved for those patients in whom conservative therapy with MCT diets or TPN has failed.
Adult↗
Treatment of chyloperitoneum after extended lymphatic dissection during duodenopancreatectomy.
BACKGROUND: Chyloperitoneum is a rare postoperative complication that might be caused by an interruption of chylous ducts in the mesenteric root or the cysterna chyli. Two cases of chyloperitoneum after duodenopancreatectomy are reported in the literature. METHODS: We here report the third case that developed a chyloperitoneum 2 wk postoperatively when he resumed his normal diet. RESULTS: The patient was treated conservatively with paracenteses and chyloperitoneum subsided thereafter. CONCLUSIONS: Chyloperitoneum after extended duodenopancreatectomy might be treated conservatively.
Adenocarcinoma↗
A rare complication of D3 dissection for gastric carcinoma: chyloperitoneum.
BACKGROUND: Chyloperitoneum is the accumulation of lymphatic fluid in the peritoneal cavity. Although uncommon, it has been reported after retroperitoneal lymph node dissection. But the incidence of this complication after radical gastrectomy is unknown. In the present study, we analyzed our patients who underwent D3 dissection for gastric carcinoma and developed chyloperitoneum. METHODS: Between June 1999 and June 2002, a total of 134 patients with gastric cancer underwent radical lymph node dissection, performed according to the Japanese Research Society for Gastric Cancer guidelines, as the standard procedure for gastric cancer treatment. Of these patients, 34 underwent D3 lymphadenectomy, and chyloperitoneum was detected in 4 of them. RESULTS: There were three male patients and one female patient. All patients were in stage III according to the International Union Against Cancer (UICC)-TNM classification. In three patient, chyle leakage was noticed during the surgery, and surgical ligation of the duct was performed. Abdominal distension developed in one patient 7 days after the surgery, and chylous ascites was diagnosed. This patient was success-fully treated with fasting and total parenteral nutrition, within 2 weeks. CONCLUSION: The incidence of chyloperitoneum is not low, and may increase with more aggressive surgery. Surgeons should be aware of this complication after retroperitoneal lymph node dissection, and injured lymphatics must be controlled and ligated intraoperatively.
Aged↗
Octreotide therapy: a new horizon in treatment of iatrogenic chyloperitoneum.
Chyloperitoneum is a rare and challenging complication of abdominal surgery. We report a case of iatrogenic chyloperitoneum. Infusion of octreotide, a somatostatin analogue, together with total parenteral nutrition followed by medium chain triglyceride diet resulted in rapid resolution of chyloperitoneum. We believe this to be the first report of successful use of octreotide in iatrogenic chyloperitoneum in a child.
Child, Preschool↗
Lymphoscintigraphy in chyluria, chyloperitoneum and chylothorax.
UNLABELLED: Lymphoscintigraphy allows functional assessment of lymphatic transport and depiction of regional lymph nodes, is fast and nontraumatic and has no known side effects. We retrospectively analyzed lymphoscintigraphic studies to determine their efficacy in the investigation of chyluria, chyloperitoneum and chylothorax. METHODS: Twenty-one whole-body lymphoscintigrams using 99mTc-antimony sulfide colloid or dextran were acquired in 18 patients with chyluria, chyloperitoneum and/or chylothorax. The images were reviewed to assess the rate of tracer transport and number, size and distribution of lymph vessels and nodes as well as the presence of collateral, fistula or lymph reflux. RESULTS: Lymphoscintigraphy was normal (5 of 11 patients) or showed lymphatic obstruction (6 of 11 patients) in chyluria associated with filariasis. Lymphatic obstruction was demonstrated in chyloperitoneum and/or chylothorax associated with liver cirrhosis (2 patients), postoperative (1 patient) or congenital (1 patient) lymphatic dysplasia, inferior vena cava obstruction (1 patient) and nephrotic syndrome (1 patient). Enhanced lymph flow was seen in systemic lupus erythematosus (1 patient). Follow-up lymphoscintigrams showed patency of lymphovenous anastomosis (1 patient), improvement (1 patient) or no change (1 patient) in lymphatic drainage after treatment. CONCLUSION: Lymphoscintigraphy can demonstrate abnormal lymphatic drainage in chyluria, chyloperitoneum and chylothorax. It is useful for selecting patients for surgery and assessing the effect of treatment.
Adult↗
Combined occurrence of chyloperitoneum and chylothorax after surgery and chemotherapy for Wilms' tumor.
Chyloperitoneum is an extremely rare complication of abdominal surgery in children and a combined occurrence of chylothorax and chyloperitoneum after abdominal surgery has never been reported in children. Chylous ascites usually occurs as a result of operative trauma to the thoracic duct, cisterna chyli, or its tributaries. About one third of all patients with chylous ascites after retroperitoneal lymph node dissection also develop secondary chylothorax. Diaphragmatic defects have been shown to be responsible for the occurrence of chylothorax secondary to chyloperitoneum. Congenital diaphragmatic weakness may result in evagination of the peritoneum causing diaphragmatic blebs, the rupture of which results in the movement of the peritoneal fluid into the pleural cavity. In the authors' patient, the rent in the diaphragm that occurred during surgery was probably responsible for the chylothorax. The role of chemotherapy, if any, in the pathophysiology of this complication is unknown. Total parenteral nutrition (TPN) is a simple and effective treatment for postoperative chylous effusions. Surgical treatments such as abdominal exploration for the repair of leaking lymphatics and peritoneovenous shunt should be reserved for patients who fail TPN.
Chylothorax↗
Fibroadhesive form of tuberculous peritonitis: chyloperitoneum in a patient undergoing automated peritoneal dialysis.
Chyloperitoneum is a rare condition in patients undergoing peritoneal dialysis. We report here a patient who developed chylous ascites during the course of tuberculous peritonitis. The diagnosis was confirmed by cultures of dialysate and peritoneal biopsy, and laparoscopy revealed severe hyperemia and intestine adhesion. Intrinsic lymphatic obstruction and superimposed peritoneal fibrosis together might be responsible for the pathogenesis of this special presentation. Although in most cases of continuous ambulatory peritoneal dialysis, the causes of chyloperitoneum remained unknown, we suggest, from the experience of this case, that tuberculous peritonitis, especially the fibroadhesive form, should be highly suspected in any dialysis cases with chyloperitoneum. Laparoscopy should be initiated early, particularly when the culture is negative for common pathogens or when the patient responds poorly to the usual antimicrobial agents.
Chylous Ascites↗
Chyloperitoneum and abdominal adhesions in a miniature horse.
Chyloperitoneum is a potential cause of colic in horses. Although rare in horses, chyloperitoneum can develop secondary to tearing of mesenteric adhesions and rupture of mesenteric lymphatic vessels. The prognosis for horses with chyloperitoneum depends on the underlying cause and the response to treatment.
Abdomen↗
[Traumatic chylothorax and chyloperitoneum].
Traumatic chylothorax and chyloperitoneum are rare. Effusion of the chyle into the pleural cavity occurs after severe injuries of the chest wall after pretentious surgical operation in the posterior mediastinum and after operations of the cardiovascular system. The authors recorded one observation after operation of a patent ductus arteriosus and controlled the situation by a conservative procedure. A traumatic chyloperitoneum develops typically after a minor or obscure injury. The pathological picture usually develops slowly, in rare instances it imitates an acute abdomen. The condition calls for laparotomy. Only in rare instances a fissure is detected in the posterior peritoneum and it is very difficult to detect the sites of injuries of lymphatic vessels. The authors treated three patients. All were operated, two were subjected to laparotomy twice. A relapsing chyloperitoneum was brought under control by hitherto non published surgical procedures: in one instance by communication of the abdomen with the posterior mediastinum, in the second case by ligature of the lymphatic vessels close to the vasa mesenterica cran. All patients recovered.
Abdominal Injuries↗
Chyloperitoneum following treatment for advanced gynecologic malignancies.
BACKGROUND: Chyloperitoneum is an uncommon complication following retroperitoneal surgery. Blunt abdominal trauma, abdominal surgery, abdominal or pelvic radiation, cirrhosis, lymphoma, tuberculosis, and congenital defects of lacteal formation may also lead to chylous ascites. CASES: Two patients developed chylous ascites after treatment for gynecologic malignancies. One, who also received pelvic and abdominal radiation, developed chylous ascites 11 months after retroperitoneal lymph node dissection for advanced endometrial cancer. She was treated with a diet low in fat and high in medium-chain triglycerides, as well as with intravenous hyperalimentation. She had recurrences of chylous ascites, which responded to paracentesis and intravenous hyperalimentation. The second patient developed chylous ascites 2 months after retroperitoneal lymph node dissection for advanced fallopian tube cancer. She was treated with a medium-chain triglyceride diet, which resulted in resolution of her symptoms. CONCLUSION: Chyloperitoneum is an uncommon complication following treatment for gynecologic malignancies. Our second case is the first reported in which retroperitoneal lymph node dissection for gynecologic malignancy resulted in chyloperitoneum. However, because gynecologic malignancies frequently metastasize to the periaortic lymph nodes, chylous ascites may be an important cause of morbidity following treatment.
Adenocarcinoma↗
[Diagnosis and therapy of postoperative chyloperitoneum].
Chyloperitoneum is a rare complication of surgical procedures. We report a case of severe chyloperitoneum after abdominothoracic esophageal resection with two-field lymphadenectomy. After diagnosis was established, the lymph leak was located with oral iodine-marked fatty acids (123I-pentadecanoic acid) showing increased activation in the right middle abdomen. Because conservative treatment with total parenteral nutrition showed no decrease in chyle volume, relaparatomy was performed and the lymphatic fistula was successfully treated with suture ligatures. Pathophysiology and different options for localization and treatment of postoperative chyloperitoneum are discussed.
Carcinoma, Squamous Cell↗
Chemotherapy treatment of chyloperitoneum and peritoneal carcinomatosis due to cervical cancer--review of literature.
We report a case of chyloperitoneum and peritoneal carcinomatosis 8 months after radiation therapy for cervical cancer and treatment with lowfat diet, diuretics, and systemic combination chemotherapy. The literature of chyloperitoneum complicating gynecological malignancies is reviewed.
Adult↗
Congenital chyloperitoneum: direct comparison of medium-chain triglyceride treatment with total parenteral nutrition.
A severe case of congenital chyloperitoneum was managed over a prolonged period by permanent drainage and replacement of lymphatic loss by fresh frozen plasma, resulting in normal development of the infant. The average daily drainage of 360 ml during a period of a medium-chain-triglyceride (MCT) diet could be reduced to 228 ml (1.58 ml/kg per h) with total parenteral nutrition, representing apparently the basal flow rate of the intestinal lymphatics. Reduction in leakage, however, did not influence the observed lymphocytopenia. Healing of the lesion within the intestinal lymphatic system occurred after a brief period of bacterial peritonitis. The rationale for treatment with an MCT diet and for the application of total parenteral nutrition in infants with chyloperitoneum is discussed.
Chylous Ascites↗
Chyloperitoneum: a postoperative complication after repair of tracheoesophageal fistula.
Chyloperitoneum is rare condition that can occur in response to various pathologic process. The authors described a newborn baby who had chyloperitoneum after primary surgical repair of esophageal atresia with tracheoesophageal fistula (Gross type C). This probably resulted from iatrogenic damage of the thoracic duct during ligation of azygous vein resulting in leaking lacteal within the intestinal wall. Biochemical analysis of ascitic fluid, plasma, and milk formula for triglyceride and cholesterol level can differentiate neonatal gastric intestinal perforation.
Chylous Ascites↗
Combined occurrence of chyloperitoneum and chylothorax after retroperitoneal surgery.
Chyloperitoneum is a rare complication of abdominal or retroperitoneal surgery, and the combined occurrence of chylothorax and chyloperitoneum has been reported in only a few cases. We describe a case of this complication, which became clinically apparent 20 days after a Warren shunt operation. The large chylous effusion compromised breathing and required chest tube drainage, pleurodesis, medium chain triglyceride (MCT) diet, and, later, total parenteral nutrition (TPN). The patient made a full recovery on TPN for 5 weeks.
Adult↗
[An analysis of 30 cases of chylothorax and chyloperitoneum].
Thirty patients diagnosed as chylothorax and chyloperitoneum (13 of chylothorax, 9 of chyloperitoneum and 8 of both) in PUMC Hospital from 1923 to 1989 were reported. Thus, the incidence rate of these two diseases is rather low. The commonest causes were iatrogenic trauma (9 cases) and malignant tumor (7 cases). Other causes were tuberculosis (5 cases), lymphangioma (2 cases), Behcet's syndrome (1 case) and non-iatrogenic trauma (1 case). The etiology was not known in 5 cases. Acute episode was observed in patients with traumatic chylous effusion; it was usually manifested as dyspnea or abdominal distention. Patients with nontraumatic chylous effusion usually run a chronic course. The characteristics of chylous effusion were analyzed. Lymphangiography and lymphoscintigraphy with 99m TC-labeled dextran play important roles in diagnosis and treatment. It has been suggested that the changes in T-cell immunocompetence is important in determining whether the treatment should be conservative or operative. If chylous effusion is due to tuberculosis, antituberculosis treatment should be instituted.
Adolescent↗
Congenital chyloperitoneum as a cause of isolated fetal ascites.
Isolated fetal ascites is an unusual prenatal finding and must be differentiated from immune and nonimmune hydrops. This entity is most commonly associated with gastrointestinal and genitourinary anomalies. Fetal chyloperitoneum, however, should be considered as a possible cause. Pulmonary hypoplasia and abdominal dystocia during attempted vaginal delivery are potential complications. We present a case of isolated fetal ascites due to congenital chyloperitoneum.
Adult↗