Chyloperitoneum After Laparoscopic Roux-en-Y Gastric Bypass (LRYGB)

Abstract

A true chylous effusion is defined as the presence of ascitic fluid with high fat (triglyceride) content, usually higher than 110 mg/dl. We report a case of chyloperitoneum following laparoscopic Roux-en-Y gastric bypass (LRYGB) in a 40-year-old patient who was admitted for surgery on May 31, 2007. On August 2008 an abdominal CT with contrast was ordered for chronic abdominal pain showing diffuse ascites as well as mesenteric adenitis. On September 2008, the patient was admitted to the hospital. An elective diagnostic laparoscopy was scheduled. A large amount of chylous fluid was found. Microscopic analysis came back negative. The patient made an uneventful recovery after surgery. To our knowledge, this is the first reported case of chylous ascites following LRYGB. Chyloperitoneum should be considered as a possible cause of ascites in patients with chronic small bowel obstruction following a LRYGB.

Long standing biliary colic masking chylous ascites in laparoscopic roux-en-Y gastric bypass; a case report

“…Up to our knowledge, only three cases of chylous ascites post LRYGB were reported. An average time for presentation with chylous ascites in these cases was 20 months [ 2 , 4 , 5 ]. In our patient, the presentation was after 9 years.…”

“…The patient was taken for a diagnostic laparoscopy where a common channel internal hernia was identified and corrected. In addition, milky fluid was extracted and analyzed, with reports showing high triglycerides levels [ 2 ].…”

“…However, only five cases have been reported in post-bariatric surgeries, three of which were after Roux en Y gastric bypass, all of them presenting 12–24 months later in in the mid post-op period. [ 2 – 5 ] We are reporting a fourth case of chylous ascites, interestingly presenting 9 years after LRYGB.…”

Chylous Ascites: Evaluation and Management

“…7.4% of patients who underwent retroperitoneal, esophageal, gastric, or cytoreductive surgeries developed CA [ 53 ]. Other surgical procedures that can result in CA include aortic and abdominal aneurysm repair [ 54 ], retroperitoneal lymph node dissection [ 55 ], inferior vena cava resection [ 56 ], catheter implantation for peritoneal dialysis [ 38 ], distal splenorenal shunts [ 57 ], small bowel transplantation [ 58 ], liver transplantation [ 59 ], choledochal cyst excision [ 60 ], pancreaticoduodenectomy [ 61 ], anterior spinal surgery [ 62 ], laparoscopic surgeries including Nissen fundoplication [ 63 ], Roux-en-Y gastric bypass [ 64 ], adrenalectomy [ 65 ], cholecystectomy [ 66 ], and donor nephrectomy [ 67 ].…”

Peritoneal Oleogranulomatosis After Laparoscopic Gastric Banding

“…15 Such lymphatic disruption may arise from exudation of chyle secondary to distal lymphatic obstruction causing retrograde increase in pressure, or as a result of direct leakage from lymphatic vessel trauma. 16 In our patient, injury to an anatomic variation of the tributaries mentioned above, as opposed to a direct insult to the TD, may have arisen after LAGB. The fact that our patient remained asymptomatic suggests a subacute or trivial chyle leak.…”