Peritoneovenous Shunting for Intractable Chylous Ascites Complicated with Lymphangioleiomyomatosis

Makino, Yuko; Shimanuki, Yuri; Fujiwara, Noriko; Morio, Yoshiteru; Sato, Koichi; Yoshimoto, Jiro; Gunji, Yoshio; Suzuki, Tsutomu; Sasaki, Shin‐ichi; Iwase, Akihiko; Kawasaki, Seiji; Takahashi, Kazuhisa; Seyama, Kuniaki

doi:10.2169/internalmedicine.47.0475

Cited by 24 publications

(10 citation statements)

References 15 publications

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“…Peritoneal disease, including Lymphangioleiomyomatosis (LAM) and peritoneal mesothelioma was also associated with higher incidence of occlusion. This is similar to previous case reports in which the shunt occluded in three out of four patients (75%) with LAM (21, 28, 32, 33). Therefore, when counseling patients with LAM, they should be advised that they are at increased risk for shunt malfunction.…”

Section: Discussionsupporting

confidence: 92%

“…Therefore, returning the chylous fluid back into the circulation is actually physiologic, though in shunt patients, the fluid is returning through an artificial conduit. Makino et al , twice infused 1000 ml of CA intravenously after paracentesis in a patient with CA and observed no coagulation abnormality (28). Additionally, in none of the 56 patients reported in the literature has DIC been observed (Table 3).…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic Application of Percutaneous Peritoneovenous (Denver) Shunt in Treating Chylous Ascites in Cancer Patients

Yarmohammadi¹,

Brody²,

Erinjeri³

et al. 2016

Journal of Vascular and Interventional Radiology

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Purpose Chylous ascites (CA) is an uncommon complication of abdominal surgeries and malignancies. The purpose of this study was to evaluate the safety and efficacy of PPVS in treating intractable CA in cancer patients. Materials and Methods 28 patients with refractory CA treated with PPVS from April 2001 to June 2015 were reviewed. Demographic characteristics, technical success, efficacy, laboratory values and complications were recorded. Univariate and multivariate logistic regression analysis was performed. Results Technical success was 100% and ascites resolved or symptoms were relieved in 92.3% (26 out of 28) of patients. In 13 (46%) of these patients with urologic malignancies, whose ascites had resulted from retroperitoneal lymph node dissection ascites resolved resulting in shunt removal within 128±84 days. The shunt provided palliation of symptoms in 13 of the remaining 15 patients (87%); mean duration of 198±214 days). Serum albumin levels increased significantly (21.4%) following PPVS placement; from a pre-procedure mean of 2.98±0.64g/dl to 3.62±0.83g/dl(p < 0.001). Post-procedure complication rate was 37%, including shunt malfunction/occlusion (22%), venous thrombosis (7%), subclinical disseminated intravascular coagulopathy (DIC) (7%). Smaller venous limb size(11.5 F) and the presence of peritoneal tumor were associated with a higher rate of shunt malfunction(p < 0.05). No patient developed overt DIC. Conclusion PPVS can safely and effectively treat CA in cancer patients, resulting in significant improvement in serum albumin in addition to palliation of symptoms.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Therapeutic Application of Percutaneous Peritoneovenous (Denver) Shunt in Treating Chylous Ascites in Cancer Patients

Yarmohammadi¹,

Brody²,

Erinjeri³

et al. 2016

Journal of Vascular and Interventional Radiology

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“…Thoracentesis or abdominocentesis also play a role in temporarily relieving symptoms such as dyspnea or distended sensation, but the repeated elimination of large amounts of chyle will result in malnutrition and a secondary immunodeficient state due to loss of nutrients and lymphocytes. 78 Diuretics seem to provide variable benefit in controlling the amount of chyle leakage and ameliorating symptoms. A fat-restricted diet alone or with supplementation of medium-chain triglycerides is generally recommended.…”

Section: Clinical Manifestations Related To Lymphatic Involvementsmentioning

confidence: 99%

“…Successful instillation of a peritoneo-venous shunt for intractable chylous ascites has also been reported by several groups. 78,92 Rapamycin, an mTOR inhibitor, is an attractive possibility since constitutively activated mTOR due to the loss of TSC1=TSC2 function is the pathogenic basis of LAM. Sirolimus, a type of rapamycin, has been successfully used for the treatment of TSC-associated diseases including LAM and AML.…”

Section: Clinical Manifestations Related To Lymphatic Involvementsmentioning

confidence: 99%

Lymphangioleiomyomatosis: A Disease Involving the Lymphatic System

Seyama

Kumasaka

Kurihara

et al. 2010

Lymphatic Research and Biology

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LAM appears to be a disease involving a dysfunction of the lymphatic system and a fascinating model of tumor dissemination that is exclusively lymphangitic. LAM-associated lymphangiogenesis that mediates the shedding of LCCs seems to play a central role in the dissemination of LAM cells and progression in LAM and it may also be a potential therapeutic target as well as the dysregulated mTOR signaling pathway.

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“…Some studies have reported success rates in the order of 90% with 6 weeks of parenteral feeding and fasting 10. Surgical management includes either open or laparoscopic approach to direct suture ligation of the chyle leakage,11 – 13 or insertion of a peritoneovenous shunt,12 and is typically reserved for cases refractory to maximal medical management.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic management of chylous ascites following laparoscopic donor nephrectomy

Sinha

Mamode

2010

Case Reports

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Laparoscopic donor nephrectomy (LDN) is an established operation for organ procurement in living donor transplantation. Living donor renal transplantation is being performed more frequently and is associated with better graft function and survival. The minimal access approach for organ procurement from healthy individuals ensures early convalescence and improved patient participation. Here we describe a rare complication of LDN. Postoperative chylous ascites frequently occurs secondary to aortic surgery. Though previously described after LDN, its treatment remains contentious. Conventional strategies have adopted an expectant approach with medical management. These include parenteral feeding, bowel rest and somatostatin analogue usage. We report laparoscopic suture ligation as the principal management of postoperative chyle leak. We advocate surgical exploration in acute onset, high output chylous ascites. Pre-existing port site incisions were used for undertaking successful laparoscopic repair. This surgical approach enabled faster convalescence and reduced hospital stay-important considerations for our healthy living donor.

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Peritoneovenous Shunting for Intractable Chylous Ascites Complicated with Lymphangioleiomyomatosis

Abstract: Abstract

Cited by 24 publications

References 15 publications

Therapeutic Application of Percutaneous Peritoneovenous (Denver) Shunt in Treating Chylous Ascites in Cancer Patients

Therapeutic Application of Percutaneous Peritoneovenous (Denver) Shunt in Treating Chylous Ascites in Cancer Patients

Lymphangioleiomyomatosis: A Disease Involving the Lymphatic System

Laparoscopic management of chylous ascites following laparoscopic donor nephrectomy

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