Postoperative chylous ascites: diagnosis and treatment. A series report and literature review
C. J. Ablan, F. N. Littooy and R. J. Freeark
Department of Surgery, Loyola University Medical Center, Maywood, Ill.
The accumulation of chylous fluid in the abdominal cavity is an infrequent
yet alarming complication in abdominal surgery. Excessive lymphatic leakage
is occasionally encountered in the course of operations at the base of the
mesentery or retroperitoneum. A source can usually be identified and the
leak controlled at the time of laparotomy by suture or clip. In the region
of presumed leakage the importance of these efforts is reinforced by the
are patient in whom such leakage persists, creating problems in recognition
and management postoperatively. The development of this complication in a
patient undergoing total abdominal colectomy and left-sided hepatic
lobectomy prompted a review of our experience and a literature review. We
report four cases of postoperative chylous ascites seen over 5 years. The
fluid accumulation followed operations on the abdominal aorta (two
patients) and on the colon and liver (one patient) and after a mesocaval
shunt procedure (one patient). Two patients responded to low-fat,
medium-chain triglyceride diets; one patient required peritoneovenous
shunting; and one patient died of progressive nutritional deterioration. We
review the recognition and management of chylous ascites based on our
experience and that reported elsewhere.
