Chyle leak post laparoscopic cholecystectomy: a case report, literature review and management options

Ong, Ferdinand; Das, Amitabha; Rajkomar, Kheman

doi:10.21037/ales-20-99

Cited by 5 publications

(11 citation statements)

References 12 publications

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“…The lymphatic vessels around the gallbladder are part of the hepatic and periportal lymphatic system. These lymphatic vessels drain lymph from the liver, gallbladder, and bile ducts, eventually converging to drain into the thoracic duct [ 5 , 6 ]. Violation of lymphatics in the area can result in chyle leak and there have been multiple cases of post-LC chyle leaks reported.…”

Section: Discussionmentioning

confidence: 99%

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Chylous drainage through percutaneous cholecystostomy: an extremely rare complication

Ellison,

Igarashi,

Kevorkian

2024

Journal of Surgical Case Reports

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Chyle leak is a rare but potentially morbid complication of abdominal surgery. There have been seven reported cases of chylous ascites following cholecystectomy, but no such occurrences are reported with percutaneous cholecystostomy tube (PCT) insertion. We report the case of a 67-year-old female with stage IVb recurrent uterine papillary serous carcinoma and extensive abdominal surgical history including a paraesophageal hernia repair, and a robotic hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, gastrocolic omentectomy, and hepatoduodenal lymphadenectomy. The patient presented with clinical findings suggestive of acute cholecystitis and decision was made to proceed with PCT placement. The PCT was dislodged and replaced during her course and several days after chylous output was noted from the PCT. The remainder of her hospital course was complicated by persistent distributive shock, adrenal insufficiency, and continued chyle leak. She ultimately was transitioned to inpatient hospice and died shortly after.

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Section: Discussionmentioning

confidence: 99%

“…(2021) documented a 48-year-old male who had chylous output from his drain in the first postoperative day following uneventful LC with cholangiogram. He had a low-volume leak and was successfully managed with a fat-free diet [ 6 ]. Cheng et al .…”

Section: Discussionmentioning

confidence: 99%

Chylous drainage through percutaneous cholecystostomy: an extremely rare complication

Ellison,

Igarashi,

Kevorkian

2024

Journal of Surgical Case Reports

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“…The rate of post-LC bile leaks ranges from 1–2% [ 4 , 5 ] with management typically involving drain placement, bile diversion using interventional radiology techniques, and/or rarely operative intervention [ 6 ]. In comparison, chyle leaks following LC is an atypical complication with limited evidence for successful management postoperatively [ 3 ]. In this report, we describe our treatment of a chyle leak with concurrent bile leak in a patient who underwent elective laparoscopic cholecystectomy at an outside hospital.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, since the cholecystectomy was performed at an outside hospital, we are unsure of what occurred during the procedure or what the patient’s anatomy was at the time of procedure. Possible mechanisms of a chyle leak include the inherent anatomy of the biliary lymphatic pathways, mechanical compression of lymphatics by an inflamed pancreas, and anatomical lymphatic variants [ 3 , 8 , 9 ]. Considering the patient presented with a simultaneous bile leak, an injury to a lymphatic pathway adjacent to the common bile duct is likely.…”

Section: Discussionmentioning

confidence: 99%

“…Common postoperative complications reported are hemorrhage, infection, and iatrogenic common bile or hepatic duct injury. An extremely rare post-LC complication is chyle leak, with only 6 reported cases in the literature [ 3 ]. This report presents one of the few reported cases of chyle leak following LC with concurrent postoperative bile leak.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic cholecystectomy: post-operative bile and chyle leaks. A case report

Philip,

Garcia,

Anika

et al. 2023

Journal of Surgical Case Reports

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One week after an elective laparoscopic cholecystectomy at an outside hospital, a 56-year-old male presented to the emergency department with right-sided abdominal pain. Computerized tomography (CT) revealed a complex fluid collection in the gallbladder fossa. The patient underwent drain placement and received broad-spectrum intravenous antibiotics. Drain output was suspicious for a chyle leak, which was confirmed by elevated fluid triglyceride levels. Magnetic resonance cholangiopancreatography (MRCP) and hepatobiliary iminodiacetic acid (HIDA) analysis showed evidence of a concurrent bile leak. After starting a low fat, high protein diet and octreotide, a common bile duct sphincterotomy with plastic stent placement was performed. The patient’s symptoms and drain output proceeded to improve. The cause of the chyle leak is unclear. However, with consideration of the patient’s concurrent bile leak, an injury to the right major lymphatic drainage pathway and adjacent bile duct is suspected.

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Chylous Ascites in Laparoscopic versus Open Surgeries: A Meta-Analysis and Review of Literature

Saleem,

Choudhry,

Ahmed

et al. 2024

Current Problems in Surgery

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Chyle leak post laparoscopic cholecystectomy: a case report, literature review and management options

Cited by 5 publications

References 12 publications

Chylous drainage through percutaneous cholecystostomy: an extremely rare complication

Chylous drainage through percutaneous cholecystostomy: an extremely rare complication

Laparoscopic cholecystectomy: post-operative bile and chyle leaks. A case report

Chylous Ascites in Laparoscopic versus Open Surgeries: A Meta-Analysis and Review of Literature

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