Somatostatin treatment of a persistent chyloperitoneum following abdominal aortic surgery

Abstract

Chyloperitoneum is an uncommon but serious complication of abdominal aortic surgery. There are no optimal guidelines for the management of chyloperitoneum. We present here our experiences regarding the treatment of chyloperitoneum with somatostatin for three patients who underwent surgery for abdominal aortic disease. Milky, odorless liquid was observed in the abdominal drain of these patients. The conservative treatment with total parenteral nutrition failed; therefore, in parallel, we initiated a somatostatin treatment as a continuous perfusion. Drain loss decreased in all up to the second day of treatment. The probable mechanisms of the somatostatin decrease the intestinal absorption of fats via the specific receptors, decrease triglyceride concentration in the thoracic duct, and attenuate lymph flow in the major lymphatic channels. The presented cases showed successful treatment using somatostatin and may be a new generation of effective treatments for chyloperitoneum.

Successful lymphatic embolization using N-butyl-2-cyanoacrylate for postoperative lymphorrhea in a patient with renal pelvic cancer

“…The cyclic peptide hormone somatostatin widely exists and influences in central nerve system, pancreas, and gastrointestinal tract [14 , 15] . Although the mechanism of decreasing lymph flow by somatostatin is not fully elucidated, one hypothesis is that somatostatin may reduce triglyceride absorption from the intestine and inhibit lymphatic flow after traversing the liver in the presence of the vagus nerve [16 , 17] . The method of inducing inflammation by injecting ethanol into the leaking space (sclerotherapy) is an attempt to heal the lymphorrhea by increasing the resistance to the destination of the lymphatic outflow.…”

Chylous complications of various severity and manifestations within diverse compartments in reconstructive vascular surgery #) #) The manuscript is dedicated to Prof. Dr. Z. Halloul

“…Chylascites (syn. : chylascos, chyloperitoneum) are a collection of chylomicrones-enriched lymphatic fluid within the abdominal cavity [13]. Causes of chylascites in reconstructive vascular surgery are direct injuries of the periaortic, interaortocaval, pericaval, pelvine and retroperitoneal lymphatic vessels (flowing into the cisterna chyli), which occur in aortic interventions in up to 81 % of cases [14].…”

“…This was continued until the ascites volume via drainage was lower than 100 mL/d. Twenty-four hours prior to the removal of the drainage, somatostatin application was stopped [13].…”

Management of Chylous Ascites with Octreotide in a Bangladeshi Child: A Case Report

“…The use of somatostatin and its analogue (octreotide) has recently been introduced into the management of iatrogenic chylothorax and chyloperitoneum in children. 6,7 Probable mechanisms of action include decrease in lymph production and its flow rate. Octreotide has become popular drug for the treatment of chylous ascites because of its ease in administration, low invasiveness, short treatment time and its high effectiveness.…”