Successful management of chylous ascites with total parenteral nutrition, somatostatin, and fibrin glue

Huang, Qi; Ge, Bujun; Li, Liming; Tu, Zhiyuan; Guo-fen, Zhang; Fan, Yue-zu

doi:10.1097/00029330-200710020-00024

Cited by 10 publications

(5 citation statements)

References 9 publications

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“…Various surgical techniques that have been successful for refractory cases include application of clips and/or fibrin glue sealants, coagulation, suture ligation, embolization, and peritoneovenous shunting. 7,20,21,22,24,26 Chylous ascites in our case was managed with intervention radiology embolization using n-BCA glue into the leakage site and surrounding lymph nodes which were identified using DCRML. A 2017 retrospective review by Nadolski et al 20 assessed the effectiveness of lymphangiography, DCRML, and lymphatic embolization in 31 patients presenting for diagnosis and treatment of refractory chylous ascites.…”

Section: Discussionmentioning

confidence: 96%

“…Support for these measures lies in the fact that fasting baseline lymphatic flow through the thoracic ducts/cisterna chyli is typically less than 1 mL per minute which is dramatically increased to greater than 200 mL per minute after a fatty meal. 18 , 24 Several authors recommend patients continue conservative therapy for 4 to 8 weeks. 3 , 7 , 12 Octreotide, a somatostatin analogue, can be used as an adjunct to dietary modifications in reducing lymphatic flow.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Massive Chylous Ascites After Living Donor Nephrectomy Successfully Treated With Lymphatic Embolization

Hiffa

Schulte

Saeed

et al. 2022

Journal of Investigative Medicine High Impact Case Reports

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Chylous ascites may result from a variety of pathological conditions, most of them from nontraumatic causes, such as congenital defects of the lymphatic system, infections, liver cirrhosis, and malignancy. Rarely, chylous ascites occurs as an iatrogenic complication after left-sided laparoscopic donor nephrectomy (LDN). Injury to the cisterna chyli and its main lymphatic tributaries around the para-aortic region intraoperatively can cause the lymphatic fluid to accumulate. There is currently no standardized treatment for chylous ascites as there have only been 54 cases documented to date. Most patients can be managed with conservative therapy. Recommended guidelines include high-protein and low-fat diet with medium-chain triglycerides. Paracentesis is often used as a diagnostic and therapeutic first-line measure with total parenteral nutrition (TPN), bowel rest, and somatostatin analogue as adjunct therapies. We present a case of massive chylous ascites refractory to conservative therapy. The patient had progressive abdominal distention and unintentional weight gain 2 weeks postoperatively warranting multiple paracenteses of >7 L of chylous fluid. Ultimately, the patient was successfully treated with lymphatic embolization using N-butyl cyanoacrylate glue.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Massive Chylous Ascites After Living Donor Nephrectomy Successfully Treated With Lymphatic Embolization

Hiffa

Schulte

Saeed

et al. 2022

Journal of Investigative Medicine High Impact Case Reports

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“…There is good evidence in the literature to support the medical management of postoperative chylous ascites 7 – 9. Some studies have reported success rates in the order of 90% with 6 weeks of parenteral feeding and fasting 10.…”

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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“…Congenital chylous ascites (CCA) is defined as the collection of milky fluid rich in triglyceride content inside the peritoneal cavity in children younger than three month of age. 1,2 It can be primary or secondary. 3,4 Primary CCA, is due to mal-development of intraabdominal lymphatic system, while the, secondary is due to neoplastic or inflammatory processes.…”

Section: Introductionmentioning

confidence: 99%

Congenital chylous as cites in a 3-month-old infant in Zaria: A case report

Abdullahi¹,

Idris²,

Mado³

et al. 2021

Nig. J. Paed.

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Congenital chylous ascites (CCA) is a rare disease that results from the maldevelopment of the intra-abdominal lymphatic system. Due to the rarity of congenital chylous ascites and the lack of standards in diagnosis and therapy, this disease constitutes a medical challenge and individual therapy seems to be extremely important. A 3-month-old girl diagnosed with congenital chylous ascites. She was managed initially with nil per oral, parenteral nutrition, medium chain triglyceride (MCT) containing oil and abdominal paracentesis, followed by octreotide. Medium chain triglyceride formula, the main stay of management was discontinued with gradual reintroduction of breast feeds. This case was selected due to the rarity of CCA and the lack of standards in the diagnosis and therapy.

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Successful management of chylous ascites with total parenteral nutrition, somatostatin, and fibrin glue

Cited by 10 publications

References 9 publications

Massive Chylous Ascites After Living Donor Nephrectomy Successfully Treated With Lymphatic Embolization

Massive Chylous Ascites After Living Donor Nephrectomy Successfully Treated With Lymphatic Embolization

Laparoscopic management of chylous ascites following laparoscopic donor nephrectomy

Congenital chylous as cites in a 3-month-old infant in Zaria: A case report

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