Therapeutic Intranodal Lymphangiography for Refractory Chylous Ascites Complicating Acute Necrotic Pancreatitis

Jardinet, Thomas; Verbeke, Len; Bonne, Lawrence; Maleux, Geert

doi:10.15403/jgld.2014.1121.272.the

Cited by 7 publications

(11 citation statements)

References 17 publications

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“…These 28 articles included 5 large original case series with > 10 patients (Category I data) and 3 small original case series with 3-9 patients (Category II data) [15,[19][20][21][22][23][24][25]. The other 20 articles included were case reports and other short reports such as letters to the editor and technical notes with < 3 patients (Category III data) [14,17,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. None of these articles included a prospective study or a randomized controlled trial.…”

Section: Literature Search and Selectionmentioning

confidence: 99%

“…Compared with Category I data and Category II data, the clinical presentation of PLL is extended, and includes also chyluria and a PLL volume of up to 6000 ml/day [26,32]. As for Category I data and Category II data, failed pretreatments to cure PLL include a range of procedures such as conservative management (e. g. low fat/high protein enteral nutrition and factor XIII products [20 ml/day for 5 days]), percutaneous radiation therapy (midabdominal area [20 Gy for 2 weeks]), minimally invasive procedures (e. g. interstitial embolization by applying glue after intranodal CL), and surgical management (e. g. peritoneal-venous shunt implantation) [26,33,36,38].…”

Section: Outcome Datamentioning

confidence: 99%

“…Lipiodol is used as the contrast material in all articles, being injected selectively with a maximum injection speed of 0.14 ml/min for transpedal CL and 0.5 ml/min for intranodal CL [41,43]. The maximum amount of Lipiodol is 12 ml for transpedal CL and 30 ml for intranodal CL, irrespective of whether unilateral or bilateral CL was performed [30,36]. X-ray imaging modalities used for CL, time point of X-ray imaging to visualize the PLL and X-ray imaging signs of PLL are comparable with Category I data and Category II data.…”

Section: Technical Aspects Of CLmentioning

confidence: 99%

“…Under consideration of Category III data, the PLL cure rate is 100 % in 4 articles with transpedal CL and 14 articles with intranodal CL (and n.s. in 2/20 articles [1 article with transpedal CL and 1 article with intranodal CL]) [17,[26][27][28][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. In the article of Hara et al with 1 patient with chylothorax (PLL volume of 1000 ml/day), intranodal CL was performed twice at an interval of 1 month (bilateral groin access for the first CL and bilateral groin and bilateral axilla access for the second CL) until PLL cure was observed [37].…”

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confidence: 99%

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Conventional Lymphangiography (CL) in the Management of Postoperative Lymphatic Leakage (PLL): A Systematic Review

Sommer

Pieper

Itkin³

et al. 2020

Rofo

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Background Postoperative lymphatic leakage (PLL) is usually managed by conservative and/or surgical treatments but these procedures can be challenging to perform and potentially clinically ineffective. Therefore, conventional lymphangiography (CL) has emerged as an important alternative. The aim of this review is to present the available outcome data on CL in the management of PLL. Method A systematic literature search (PubMed) using the MeSH term “lymphangiography” was performed and the search was restricted to literature published between January 2007 and August 2019. Identification, screening, and assessment for eligibility and inclusion were conducted in accordance with PRISMA. Results From the initially obtained 1006 articles (identification), 28 articles with a total of 201 patients were finally included (inclusion). The methodological quality of all included articles corresponds to level 4 (Oxford Centre for Evidence-based Medicine – Levels of Evidence, March 2009). PLL occurs after oncological and non-oncological surgery in the form of chylothorax, chylous ascites, and cervical, thoracic, abdominal and peripheral lymph fistula and/or lymphocele. The technical success rate of CL is 75–100 %. Access for CL is transpedal (176 patients) or intranodal (25 patients). Lipiodol is used as the contrast material in all articles, with a maximum amount of 20 ml for transpedal CL and 30 ml for intranodal CL. The X-ray imaging modalities used for CL are fluoroscopy, radiography and/or CT. Two articles report CL-associated major complications and CL-associated morbidity and mortality. The PLL cure rate is 51–70 % for transpedal CL (time to PLL cure: 2–29 days) and 33–100 % for intranodal CL (time to PLL cure: 2–< 30 days). Bailout procedures in the case of clinically ineffective CL include a range of treatments. Conclusion CL is feasible, safe, and effective in the management of PLL. Lipiodol as the contrast material is essential in CL because the highly viscous iodinated poppy-seed oil has not only diagnostic but therapeutic effects. Guidelines and randomized controlled trials are further steps towards defining the ultimate value of CL. Key Points: Citation Format

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Section: Literature Search and Selectionmentioning

confidence: 99%

Section: Outcome Datamentioning

confidence: 99%

Section: Technical Aspects Of CLmentioning

confidence: 99%

mentioning

confidence: 99%

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Conventional Lymphangiography (CL) in the Management of Postoperative Lymphatic Leakage (PLL): A Systematic Review

Sommer

Pieper

Itkin³

et al. 2020

Rofo

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“…Chylous ascites is defined as a build-up of lymph within the abdomen due to obstruction in the abdominal lymphatic system [27]. Normally, the lymphatic system returns interstitial fluid and proteins to the venous circulation via lymphatic vessels to the lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

3-Methylcholanthrene Induces Chylous Ascites in TCDD-Inducible Poly-ADP-Ribose Polymerase (Tiparp) Knockout Mice

Cho

Bott

Ahmed

et al. 2019

IJMS

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TCDD-inducible poly-ADP-ribose polymerase (TIPARP) is an aryl hydrocarbon receptor (AHR) target gene that functions as part of a negative feedback loop to repress AHR activity. Tiparp−/− mice exhibit increased sensitivity to the toxicological effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), including lethal wasting syndrome. However, it is not known whether Tiparp−/− mice also exhibit increased sensitivity to other AHR ligands. In this study, we treated male Tiparp−/− or wild type (WT) mice with a single injection of 100 mg/kg 3-methylcholanthrene (3MC). Consistent with TIPARP’s role as a repressor of AHR signaling, 3MC-treated Tiparp−/− mice exhibited increased hepatic Cyp1a1 and Cyp1b1 levels compared with WT mice. No 3MC-treated Tiparp−/− mice survived beyond day 16 and the mice exhibited chylous ascites characterized by an accumulation of fluid in the peritoneal cavity. All WT mice survived the 30-day treatment and showed no signs of fluid accumulation. Treated Tiparp−/− mice also exhibited a transient and mild hepatotoxicity with inflammation. 3MC-treated WT, but not Tiparp−/− mice, developed mild hepatic steatosis. Lipid deposits accumulated on the surface of the liver and other abdominal organs in the 3MC-Tiparp−/− mice. Our study reveals that Tiparp−/− mice have increased sensitivity to 3MC-induced liver toxicity, but unlike with TCDD, lethality is due to chylous ascites rather than wasting syndrome.

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Primary chylous peritonitis: a rare case report from Syria

Haj Osman

2024

Annals of Medicine &Amp; Surgery

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Introduction and Importance: Chylous peritonitis is characterized by the sudden accumulation of chyle in the peritoneal cavity, leading to symptoms of an acute abdomen. This condition is quite rare, with less than 100 cases documented in the medical literature, and is often misdiagnosed. Case Presentation: We present a case of an acute abdomen in a young man who was initially suspected to have a perforated peptic ulcer. After laparotomy, the diagnosis of chylous peritonitis was confirmed. Despite extensive investigations, no underlying cause was identified. Treatment involved peritoneal lavage and placement of a pelvic drainage tube, with discharge after three days on a low-fat diet and no recurrence. Clinical Discussion: Chylous peritonitis is a relatively rare condition, occurring in approximately 1 in 20,000 individuals. Chyle leakage can be detected through various diagnostic modalities including ultrasound, computed tomography, laparoscopy, or exploratory laparotomy. In cases where a definitive etiology is not identified, treatment typically involves peritoneal lavage and drainage. Postoperative management focuses on a low-fat diet and somatostatin administration to prevent recurrence. Conclusion: The present case highlights the importance of considering primary chylous peritonitis as a potential cause of acute abdomen in young patients. Future research should focus on identifying risk factors and establishing evidence-based guidelines for approaching this condition.

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Therapeutic Intranodal Lymphangiography for Refractory Chylous Ascites Complicating Acute Necrotic Pancreatitis

Cited by 7 publications

References 17 publications

Conventional Lymphangiography (CL) in the Management of Postoperative Lymphatic Leakage (PLL): A Systematic Review

Conventional Lymphangiography (CL) in the Management of Postoperative Lymphatic Leakage (PLL): A Systematic Review

3-Methylcholanthrene Induces Chylous Ascites in TCDD-Inducible Poly-ADP-Ribose Polymerase (Tiparp) Knockout Mice

Primary chylous peritonitis: a rare case report from Syria

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