Chylous Ascites After Anterior Resection for Rectal Carcinoma: A Rare But Significant Incident

Abstract

Chylous ascites specifically after anterior resection for rectal cancer has not been documented in the literature thus far. All previously reported postoperative chylous ascites developed in other types of malignancies and were diagnosed within a few days of surgery. However, the patient we report had symptoms 2 years after surgery. Intraoperatively, chylous ascites was found with multiple lymph node metastasis in the small bowel mesentery and retroperitoneal region. The rarity of chylous ascites after anterior resection in rectal carcinoma is documented and discussed.

Chylous ascites as a complication of laparoscopic colorectal surgery

“…Chylous ascites after colorectal surgery is considered to be very rare, and its true incidence remains unclear. Only one study has been reported that describes the incidence of this condition after colorectal surgery in a large population, although there have been several case reports . However, there have been no published data analyzing the etiology, incidence, and treatment of chylous ascites after laparoscopic colorectal surgery.…”

Postoperative chylous ascites after colorectal cancer surgery

“…Our PubMed search for all relevant literature on chylous ascites after colorectal surgery revealed several case reports [8,9,[12][13][14], but extensive information is not available. Hence, the diagnostic criteria, epidemiology, Surg Today (2012) 42:724-728 725 onset features, and treatment of chylous ascites after colorectal cancer remain unclear.…”

“…Expanded lymph node dissection may have caused the higher frequency of chylous ascites in our patient population. We found one published case each of chylous ascites after right hemicolectomy with D3 lymphadenectomy for colorectal cancer, after low anterior resection with D3 lymphadenectomy for colorectal cancer, and after paraaortic lymphadenectomy for recurrent colorectal cancer [8,9,12,13]. A connection between the range of lymph node dissection and the frequency of chylous ascites following colorectal cancer surgery has not been established.…”

“…The most effective treatment is intraoperative identification of the source of chylous leakage and Patients who do not respond to this treatment may be responsive to somatostatin, which can reduce lymph fluid excretion through specific receptors found in the intestinal wall of lymphatic vessels [2]. Somatostatin has been shown to reduce the output of lymphatic leakage after 24-72 h [12]. In some case reports, concomitant fasting and treatment with subcutaneous octreotide, a synthetic analog of somatostatin, were effective and the patient did not require surgery [8][9][10].…”

Etiology, Diagnosis and Treatment of Lymphocutaneous Fistulas, Chylascites and Chylothorax as Infrequent but Serious Complications Following Surgical Procedures*

“…In malignant tumours, accumulation of chyle is mainly related to infiltrative growth with consecutive obstruction of lymphatic vessels by tumour cells or external tumour compression. Due to a permanent loss of fluids, proteins, vitamins, fat and T cells, chylous ascites results in malnutrition, dehydration and immune deficiency [31]. Clinically, patients mainly present with a painless distended abdomen, nausea, edema, palpable lymph nodes or with non-specific abdominal pain.…”