The Diagnosis and Management of Postoperative Chylous Ascites

Abstract

Various management modalities may be used successfully to treat chylous ascites. Therefore, treatment should be individualized and adjusted to the severity of lymphatic leakage and its consequences. The outcome mostly depends on the underlying pathological condition. Thus, in the absence of malignant or congenital underlying pathology the prognosis in cases of postoperative chylous ascites is good with the majority responding to conservative measures.

Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review

“…Below the diaphragm, the lymphatic system is comprised of vessels following the aorta and inferior vena cava upward into the retroperitoneum [7,10]. The cisterna chyli is formed by union of two lumbar lymphatic trunks and an intestinal trunk anterior to the L1 or L2 vertebra [5].…”

“…It is only after the contribution of chylomicron from the intestinal trunk that the characteristic whitish and milky chyles appear. It ascends through the aortic hiatus of the diaphragm and enters the posterior mediastinum [5,10]. It then traverses in proximity with the aorta before crossing over to the left side of the thorax (at T5 level) and emptying into either the left subclavian or internal jugular vein [5,10].…”

“…It ascends through the aortic hiatus of the diaphragm and enters the posterior mediastinum [5,10]. It then traverses in proximity with the aorta before crossing over to the left side of the thorax (at T5 level) and emptying into either the left subclavian or internal jugular vein [5,10]. The diagnosis of chylous leakage is confirmed by its typical milky white appearance as well as by laboratory analysis of the fluid that consists of high amounts of triglycerides but small amounts of cholesterol [11].…”

“…The etiology of this clinical entity is injury of retroperitoneal lymphatic vessels. However, because of the rich lymphatic network that reroute the disrupted lymphatic flow, chylous leakage usually heals spontaneously and seldom becomes clinically evident [10,14].…”

“…Traditional or surgical management has been extensively discussed and universally applied in various etiologies of chylous leakage [5,10]. For postoperative leakage, especially after an anterior spinal surgery, some unique and important characteristics exist.…”