Chylous Ascites Post Open Cholecystectomy After Severe Pancreatitis

  • Cherry X Cheung Department of Surgery, Adelaide and Meath Incorporating the National Children’s Hospital. Tallaght, Dublin, Ireland
  • Michael E Kelly Department of Surgery, Adelaide and Meath Incorporating the National Children’s Hospital. Tallaght, Dublin, Ireland
  • Omer El Tayeb Department of Surgery, Adelaide and Meath Incorporating the National Children’s Hospital. Tallaght, Dublin, Ireland
  • William C Torregianni Department of Surgery, Adelaide and Meath Incorporating the National Children’s Hospital. Tallaght, Dublin, Ireland
  • Paul F Ridgway Department of Surgery, Adelaide and Meath Incorporating the National Children’s Hospital. Tallaght, Dublin, Ireland
Keywords: Chyle, Chylous Ascites, Lymphatic Vessels, Pancreatitis, Postoperative Complications

Abstract

Context Chylous ascites a rare complication post cholecystectomy. There are to our knowledge only 3 reported cases in the literature. We describe a case of chylous ascites post open cholecystectomy in a patient with recent severe pancreatitis. We propose a potential relationship between acute biliary pancreatitis and the development of chylous ascites. Case report We present a 37 year old man with a history of severe biliary pancreatitis 10 months prior. He was electively admitted for laparoscopic cholecystectomy. His surgery was converted to open cholecystectomy due to adhesions. A closed, non suction drain was placed intraoperatively draining serosanguinous fluid. Two days post operatively the draining fluid changed to a milky colour fluid with high triglyceride level. Chylous ascites was confirmed clinically with a 24 hour fast. He was treated with total parenteral nutrition. His chylous ascites resolved with conservative management and his drain was removed. Conclusion We describe the diagnosis and management of chylous ascites post cholecystectomy. We propose the hypothesis to the aetiology of this rare condition, based on ours and one previous case, that a history of recent severe acute pancreatitis poses a risk factor in the development of chylous ascites.

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References

Cárdenas A, Chopra S.. Chylous ascites. Am J Gastroenterol. 2002 Aug;97(8):1896-900.

Huang YM, Chen JH, Liu SH, Lin MT: Chlye leakage after laparoscopic cholecystectomy for acute biliary pancreatitis: a case report. Hepatogastroenterology, 2009 Jan-Feb;56(89):39-42

Jensen EH Weiss CA, 3rd: Management of chylous ascites after laparoscopic cholecystectomy using minimally invasive techniques: A case report and literature review. Am Surg 2006; 72:60-63

Gogalniceanu P, Purkayastha S, Salding D, Zacharakis E: Chyle leak following laparoscopic cholecystectomy: a rare complication. Ann R CollSurgEngl 2010 Oct;92(7):W12-4. Epub 2010 Aug 9.

Leibovitch I, Mor Y, Golomb J, Ramon J: The diagnosis and management of postoperative chylous ascites (review). J Urol 2002:167:449-457

Baniel J, Foster RS , Rowland RG, et al: Management of chylous ascites after retroperitoneal lymph node dissection for testicular cancer. J Urol 1993; 150:1422-1424

Oliver O. Aalami, MD, Daniel B. Allen, MD, and Claude H. Organ, Jr, MD: Chylous ascites: A collective review, Surgery 2000; 128:761-78

Wegner R. Das Anatomenbildnis: seine Entwickelungim Zusammenhangmit der Anatomischen Abbildung. Basel,Switzerland: BennoSchwabe and Co; 1939.

Hibbeln J, Wehmueller M, Wilbur A. Chylous ascites: CT and ultrasound appearance. Abdominal Imaging 1995; 20:138-40

Wu Zhao, Guan Rui, HuiNing, XuMingjuan. Chylous ascites after whole pelvis suspension case report and literature review. Journal of Medical Colleges of PLA 25 (2010) 58–61

Halloul Z, Meyer F, Burger T Lippert H: Chylous ascites, a rare complication of aortic surgery. Vasa 1995;24:377-381

Malik HZ, Crozier J, Murray L, Carter R: Chyle Leakage and early enteral feeding following pancreatico- duodenectomy: management options. Dig Surg 2007;24:418-422

Haug ES, Saether OD, OdengaardA ,Johnsen G, Myhre HO: Chylous complications after abdominal aortic surgery. IntAngiol 1998; 17:244-247

Petrasek AJ, Ameli FM: Conservative management of chylous ascites complicating aortic surgery: a case report. Can J Surg 1996;39:499-501

Geisler JP, Foster RS, Sutton GP: Chyloperitonerm following treatment for advanced gynaecologicmalignancies.ObstetGynecol 1994;83:883-885

Bhat AL, Lower GI: Chylous injury following anterior spinal surgery: case reports. Eur Spine J 1997;6:270-272

Elwart Garret H jr, Richardson JW, Howard HS, Garret. Retroperitoneal lymphocele after abdominal aortic surgery. J VascSurg1989; 10: 245-253

Fleisher HL, Oren LW, Summer DS. Chylous ascites after abdominal aortic aneurysmectomy. Successful management with a peritoneovenous shunt. J VascSurg1987; 6: 403-407

Guillem P, Papachristos I, Peillon C, Triboulet JP. Etilefrine use in the management of post-operative chyle leaks in thoracic surgery. Interactive Cardiovascular and thoracic surgery 2004;3 : 156-160

BhatiaC, PratapU, Slavik :Octreotide therapy: A new horizon in treatment of iatrogenic chyloperitoneum. Arch Dis Child 2001;85:234-235

Miller E, Wiener L, Bloomsfield D. Etilefrine in the treatment of levodopa-induced orthostatic hypotension. Arch Neurol. 1973;29:99-103

Milsom JW, Kron IL, Rheuban KS, Rodgers BM. Chylothorax: an assessment of current surgical management. J ThoracCardiovasc Surg. 1985;89:221-227

Kaas R, Rustman LD, Zoetmulder FAN. Chylous ascites after oncological abdominal surgery: incidence and treatment. EJSO 2001; 27: 187–189

CT abdomen showing haemorrhagic pancreatitis with drain in situ.
Published
2012-05-10
How to Cite
Cheung, C., Kelly, M., El Tayeb, O., Torregianni, W., & Ridgway, P. (2012). Chylous Ascites Post Open Cholecystectomy After Severe Pancreatitis. JOP. Journal of the Pancreas, 13(3), 278-281. https://doi.org/10.6092/1590-8577/524
Section
CASE REPORTS