The conservative treatment of postoperative chylous ascites in gynecologic cancers: four case reports

Abstract

Chylous ascites should be considered in the differential diagnosis of abdominal distension following retroperitoneal surgery. Cases generally respond well to conservative treatment. However, treatment options should be personalized, and the right treatment should be chosen for each patient. The best measure is to pay utmost attention to the ligation of large lymph vessels during lymph dissection.

Octreotide therapy for the management of refractory chylous ascites after a staging operation for endometrial adenocarcinoma

“…Similar results were obtained in a case series of chyloperitoneum, where the responses were evident in <72 h . However, in other studies, the treatment was continued for up to 6 weeks and the absence of symptom recurrence was reported . In these cases, and ours, surgical intervention could be avoided because of extension of the duration of therapy.…”

“…The efficacy of octreotide has been confirmed by recent case reports of patients undergoing primary surgery for gynecologic cancers (Table ) . Most of them initially exhibited considerable leakage of chylous fluid, but they responded well to octreotide (100–150 μg subcutaneously every 8 h).…”

“…The traditional approaches, which are primarily conservative, include paracentesis, low‐fat diets, and parenteral nutrition. A review of the literatures showed that the recommended management strategies for chylous ascites are based on a step‐up approach from conservative treatment to surgical intervention . Conservative treatment methods usually take several weeks to alleviate the symptoms and may take up to 2 months in some protracted cases.…”

Lymphography with Patent Blue for Identification of Lymphatic Fistula After Radical Hysterectomy

“…1 The English scientific literature included 33 case reports of chylous ascites in gynecologic cancers by 2011, with only five cases describing ascites after retroperitoneal lymph node dissection without adjuvant radiotherapy. 3 The diagnosis of a urinary tract fistula may be confirmed by biochemical and cytological examination of the fluid obtained from the vaginal secretion. Lymph has a protein content of 1-6 g/dL fat and electrolyte concentration similar to that of serum and 2,000 to 20,000 white blood cells/mm 4 consisting primarily of lymphocytes, which is markedly different from urine.…”

“…1,2 Rarely, this type of fistula may appear as ascites. 3 With rapid diagnosis and appropriate management, the prognosis is good. 2,4 However, the treatment for this type of fistula is complex.…”