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Abstract
RATIONALE Lymphoma with an initial manifestation of ascites and peritoneal invasion is rare. PATIENT CONCERNS A 65-year-old woman presented to the emergency department with a 3-week history of abdominal distention, anorexia, and night sweating, and a 2-week history of melena. She was a silent hepatitis B virus carrier. Abdominal ultrasound showed massive ascites without cirrhosis. Abdominal computed tomography revealed ascites, infiltrative peritoneal lesions with omental cake appearance, and lymphadenopathies. DIAGNOSIS We performed paracentesis and the ascites cytology was obtained. The patient also underwent esophagogastroduodenoscopy, which showed ulcerative tumors in the stomach. Both ascites cytology and pathology of the gastric tumors confirmed the diagnosis of B-cell lymphoma. INTERVENTIONS This patient received 7 cycles of chemotherapy. OUTCOMES Follow-up imaging studies revealed partial remission of lymphoma, but an enlargement of residual tumors in omentum and mesentery, which resulted in intractable ascites and rapid deterioration of performance status. Despite a change of regimen of chemotherapy, this patient expired 10 months after diagnosis. LESSONS Lymphoma should be one of the differential diagnoses in patients with intractable ascites not attributable to other comorbidities.
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MESH Headings
- Aged
- Antineoplastic Agents/therapeutic use
- Ascites/etiology
- Diagnosis, Differential
- Endoscopy, Digestive System/methods
- Fatal Outcome
- Female
- Humans
- Hypertension, Portal/complications
- Hypertension, Portal/diagnosis
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Paracentesis
- Peritoneal Neoplasms/diagnosis
- Peritoneal Neoplasms/secondary
- Peritoneum/pathology
- Positron-Emission Tomography
- Stomach Neoplasms/diagnosis
- Stomach Neoplasms/drug therapy
- Stomach Neoplasms/pathology
- Tomography, X-Ray Computed
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Affiliation(s)
| | - Jyh-Seng Wang
- Department of Pathology and Lab Medicine, Kaohsiung Veterans General Hospital
| | - Wen-Chi Yang
- Division of Hematology and Medical Oncology, Department of Internal Medicine, E-Da Hospital
- I-Shou University, Kaohsiung, Taiwan
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52
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Pilania RK, Jindal AK, Sandesh G, Vignesh P, Suri D, Nada R, Singh S. Chylous ascites and podocytopathy as the presentation of childhood lupus-an unusual occurrence. Lupus 2018; 28:244-248. [PMID: 30526330 DOI: 10.1177/0961203318817831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disorder that can affect virtually any organ. Chylous ascites as a presenting manifestation of SLE has been described in a handful of cases in adults. However, to the best of our knowledge this presentation has never been reported in the pediatric age group. Podocytopathy in SLE was initially considered to be a chance association. However, more recently it has been suggested that minimal change disease is not only a chance association; it is part of the lupus nephritis spectrum.
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Affiliation(s)
- R K Pilania
- 1 Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A K Jindal
- 1 Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - G Sandesh
- 1 Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - P Vignesh
- 1 Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D Suri
- 1 Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Nada
- 2 Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Singh
- 1 Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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53
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Nayi V, Wang Y, Galen B. When Appearance Is Everything: Chylous Ascites. Am J Med 2018; 131:1314-1316. [PMID: 30006131 DOI: 10.1016/j.amjmed.2018.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Vipul Nayi
- Department of Internal Medicine, Internal Medicine Residency Training Program
| | | | - Benjamin Galen
- Department of Internal Medicine, Division of Hospital Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
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55
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Chylous ascites, anti-interferon-gamma autoantibody, and angioimmunoblastic T-cell lymphoma: a rare but intriguing connection over Mycobacterium avium. Med Microbiol Immunol 2018; 208:33-37. [PMID: 30083859 DOI: 10.1007/s00430-018-0555-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 08/01/2018] [Indexed: 12/19/2022]
Abstract
We report a case of non-AIDS (acquired immunodeficiency syndrome), non-CAPD (Continuous Ambulatory Peritoneal Dialysis), non-cirrhotic, Mycobacterium avium peritonitis, which is a rare form of mycobacterial infection. A 66-year-old Japanese man who had been treated previously for angioimmunoblastic T-cell lymphoma (AITL), had developed disseminated M. avium infection. Antimycobacterial regimen improved his symptoms; however, following an interruption in treatment, he developed chylous ascites. The patient died of uncontrolled peritonitis despite intensive treatment. Anti-interferon-γ autoantibody was positive, and AITL was presumed to be involved in autoantibody production. A rare coexistence of chylous ascites, autoantibody, and AITL taught us an intriguing lesson on the pathogenesis of M. avium infection. Particularly, we conclude that treatment strategies for M. avium infection should aim to restore immunity.
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56
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Mandavdhare HS, Sharma V, Singh H, Dutta U. Underlying etiology determines the outcome in atraumatic chylous ascites. Intractable Rare Dis Res 2018; 7:177-181. [PMID: 30181937 PMCID: PMC6119674 DOI: 10.5582/irdr.2018.01028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Chylous ascites is an uncommon entity and infectious etiology is the most common cause in developing countries. However, recently, whether there is any change in trend of etiologies in developing countries is not known. In this study, a retrospective analysis of the data of cases of atraumatic chylous ascites was conducted. Twelve patients of atraumatic chylous ascites with a mean age of 35 years were studied and 6 of them were males. The mean duration of symptoms was 9.6 months and the clinical presentation was abdominal distension (12 cases), pain abdomen (10 cases), loss of appetite and weight (9 cases), peripheral lymphadenopathy (4 cases) and fever (3 cases). Etiologies were tuberculosis (3 cases), malignancy (2 cases), radiotherapy related (2 cases), pancreatitis related (2 cases), lymphatic malformation (2 cases) and multifactorial (1 case). Eight improved with conservative measures, 2 were lost to follow up and 2 died. Our outcomes found infectious etiology still as the most common cause of atraumatic chylous ascites. Benign treatable causes could be managed successfully with conservative measures while malignant etiology had a poor prognosis. Underlying etiology determines the outcome in atraumatic chylous ascites.
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Affiliation(s)
- Harshal S Mandavdhare
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Address correspondence to:Dr. Harshal S Mandavdhare, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh160012, India. E-mail:
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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57
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Mandavdhare HS, Sharma V, Singh H, Dutta U. WITHDRAWN: Underlying etiology determines the outcome in atraumatic chylous ascites. Biosci Trends 2018. [PMID: 30012891 DOI: 10.5582/bst.2018.01028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ahead of Print article withdrawn by publisher. This withdrawal is for above article due to the misoperation of advance online publication.
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Affiliation(s)
- Harshal S Mandavdhare
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research
| | - Harjeet Singh
- Department of Surgery, Postgraduate Institute of Medical Education and Research
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research
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58
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59
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Bhardwaj R, Vaziri H, Gautam A, Ballesteros E, Karimeddini D, Wu GY. Chylous Ascites: A Review of Pathogenesis, Diagnosis and Treatment. J Clin Transl Hepatol 2018; 6:105-113. [PMID: 29577037 PMCID: PMC5863006 DOI: 10.14218/jcth.2017.00035] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 09/26/2017] [Accepted: 09/30/2017] [Indexed: 12/12/2022] Open
Abstract
Chylous ascites (CA) is a rare form of ascites that results from the leakage of lipid-rich lymph into the peritoneal cavity. This usually occurs due to trauma and rupture of the lymphatics or increased peritoneal lymphatic pressure secondary to obstruction. The underlying etiologies for CA have been classified as traumatic, congenital, infectious, neoplastic, postoperative, cirrhotic or cardiogenic. Since malignancy and cirrhosis account for about two-thirds of all the cases of CA in Western countries, in this article we have attempted to reclassify CA based on portal and non-portal etiologies. The diagnosis of CA is based on the distinct characteristic of the ascitic fluid which includes a milky appearance and a triglyceride level of >200 mg/dL. The management consists of identifying and treating the underlying disease process, dietary modification, and diuretics. Some studies have also supported the use of agents such as orlistat, somatostatin, octreotide and etilefrine. Paracentesis and surgical interventions in the form of transjugular intrahepatic portosystemic shunt (commonly known as TIPS), peritoneal shunt, angiography with embolization of a leaking vessel, and laparotomy remain as treatment options for cases refractory to medical management.
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Affiliation(s)
- Richa Bhardwaj
- Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT, USA
- *Correspondence to: Richa Bhardwaj, Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT 06030, USA. Tel/Fax: +1-860-679-4613, E-mail:
| | - Haleh Vaziri
- Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT, USA
| | - Arun Gautam
- Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT, USA
| | | | - David Karimeddini
- Department of Diagnostic Imaging and Therapeutics, UCONN Health, Farmington, CT, USA
| | - George Y. Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT, USA
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60
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Mukherjee A, Sehgal IS, Mittal BR, Dhooria S. Transudative chylothorax: an uncommon illness due to a common cause. BMJ Case Rep 2018; 2018:bcr-2017-223158. [PMID: 29437722 DOI: 10.1136/bcr-2017-223158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Chylothorax is defined as presence of chyle in the pleural space. It is commonly associated with cardiothoracic surgery, trauma, malignancy or some benign disorders. Transudative chylothorax is uncommon. A 52-year-old man presented with bilateral chylothorax with preceding history of blunt trauma to the chest. On further evaluation, he was diagnosed to have a transudative chylothorax due to cirrhosis of liver with coexisting chylous ascites and evidence of peritoneopleural communication. The patient was managed with diuretics followed by chemical pleurodesis with iodopovidone.
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Affiliation(s)
- Arindam Mukherjee
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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61
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Abstract
Retroperitoneal fibrosis is a rare condition characterized by chronic inflammation and marked fibrosis of the retroperitoneal tissue, often leading to entrapment of abdominal organs. We report a 69-year-old white man who presented with a 5-week history of gradual onset of progressive abdominal distension. He had no history or risk factors for an underlying liver condition. Ascites and a retroperitoneal mass encasing the major abdominal vessels were revealed on imaging. Biopsies of the mass confirmed the presence of retroperitoneal fibrosis, and the ascitic fluid was milky, consistent with chylous ascites. We discuss this rare presentation and the challenges of treatment for chylous ascites caused by RPF, including the role for supportive treatment.
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62
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Lizaola B, Bonder A, Trivedi HD, Tapper EB, Cardenas A. Review article: the diagnostic approach and current management of chylous ascites. Aliment Pharmacol Ther 2017; 46:816-824. [PMID: 28892178 DOI: 10.1111/apt.14284] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 07/15/2017] [Accepted: 08/11/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Chylous ascites is rare, accounting for less than 1% of cases. An appropriate and stepwise approach to its diagnosis and management is of key importance. AIM To review the current diagnostic approach and management of chylous ascites. METHODS A literature search was conducted using PubMed using the key words 'chylous', 'ascites', 'cirrhosis', 'pathophysiology', 'nutritional therapy', 'paracentesis", "transjugular intrahepatic portosystemic shunt" and "TIPSS'. Only articles in English were included. RESULTS Chylous ascites is caused by the traumatic or obstructive disruption of the lymphatic system that leads to extravasation of thoracic or intestinal lymph into the abdominal space and the accumulation of a milky fluid rich in triglycerides. The most common causes are malignancy, cirrhosis and trauma after abdominal surgery. This condition can lead to chyle depletion, which results in nutritional, immunologic and metabolic deficiencies. An ascitic triglyceride concentration above 200 mg/dL is consistent with chylous ascites. Treatment is based on management of the underlying cause and nutritional support. CONCLUSIONS Chylous ascites is mostly due to malignancy and cirrhosis in adults, and congenital lymphatic disorders in children. Treatment with nutritional optimization and management of the underlying etiology are the cornerstones of therapy. When conservative measures fail, other interventions such as octreotide/somatostatin analogues, surgical ligation, embolization and transjugular intrahepatic portosystemic shunt in patients with cirrhosis can be considered.
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Affiliation(s)
- B Lizaola
- Department of Medicine, St. Elizabeth Medical Center, Brighton, MA, USA
| | - A Bonder
- Liver Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - H D Trivedi
- Liver Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - E B Tapper
- Department of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - A Cardenas
- GI/Liver Unit, Institute of Digestive Diseases and Metabolism, University of Barcelona, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona, Spain
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63
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Daniel A, Bagnato G, Vital E, Del Galdo F. Chylous ascites in a patient with an overlap syndrome: a surprising response to rituximab. BMJ Case Rep 2017; 2017:bcr-2017-222339. [PMID: 29054902 DOI: 10.1136/bcr-2017-222339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The authors present a case of a 51-year-old woman with clinical diagnosis of mixed connective tissue disease and overlap systemic lupus erythematosus features, with a 6-month history of progressive painless abdominal distension. On examination, evident signs of ascites were present. Both the abdominal-pelvic ultrasound and CT scan confirmed a large amount of ascites. A diagnostic paracentesis was performed, which revealed typical features of chylous ascites (CA). An extensive diagnostic work-up led by a multidisciplinary team was performed, excluding malignancy, cirrhosis, infectious, as well as cardiac and primary lymphatic causes. The patient was kept under surveillance, with dietary therapy and periodic ascitic drainages. The hypothesis of an autoimmune cause for CA was considered by exclusion. Rituximab therapy was initiated and an excellent response was achieved, with reduction of the rate of accumulation of CA and an increase in quality of life of the patient.
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Affiliation(s)
- Alexandra Daniel
- Department of Rheumatology Unit, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Gianluca Bagnato
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Edward Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Francesco Del Galdo
- Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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64
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Poo S, Pencavel TD, Jackson J, Jiao LR. Portal hypertension and chylous ascites complicating acute pancreatitis: the therapeutic value of portal vein stenting. Ann R Coll Surg Engl 2017; 100:e1-e3. [PMID: 29046075 DOI: 10.1308/rcsann.2017.0078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chylous ascites as a consequence of acute pancreatitis is very rare. We present an unusual case of a 73-year-old man who developed refractory chylous ascites one month after an acute severe episode of gallstone pancreatitis, associated with portal hypertension. He was successfully treated with portal vein stenting, which has remained patent to date.
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Affiliation(s)
- S Poo
- Department of Hepatobiliary and Pancreatic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust , London
| | - T D Pencavel
- Department of Hepatobiliary and Pancreatic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust , London
| | - J Jackson
- Interventional Radiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust , London
| | - L R Jiao
- Department of Hepatobiliary and Pancreatic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust , London
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65
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Razanamahery J, Jacquier A, Humbert S. A Rare Case of Chylous Ascites. Gastroenterology 2017; 153:903-905. [PMID: 28881191 DOI: 10.1053/j.gastro.2017.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/27/2017] [Accepted: 04/05/2017] [Indexed: 12/02/2022]
Affiliation(s)
- Jérôme Razanamahery
- Service de Médecine Interne, Centre Hospitalier Universitaire de Besançon, France
| | - Anthony Jacquier
- Service de Pathologie, Centre Hospitalier Universitaire de Besançon, France
| | - Sébastien Humbert
- Service de Médecine Interne, Centre Hospitalier Universitaire de Besançon, France
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66
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A Rare Case of Angioimmunoblastic T-Cell Lymphoma with Epstein-Barr Virus-Negative Reed-Sternberg-Like B-Cells, Chylous Ascites, and Chylothorax. Case Rep Hematol 2017; 2017:1279525. [PMID: 28487786 PMCID: PMC5405369 DOI: 10.1155/2017/1279525] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/15/2017] [Indexed: 12/14/2022] Open
Abstract
Angioimmunoblastic T-cell lymphoma is a rare non-Hodgkin lymphoma with dismal prognosis. The median age of presentation ranges from 62 to 69 years with generalized lymphadenopathy, B symptoms, and hepatosplenomegaly as the most prevalent symptoms. The combination of B-cell and T-cell proliferations is common in AITL and the B-cell component may resemble Reed-Sternberg-like B-cells. Epstein-Barr virus is estimated to be present in 80–95% of AITL biopsies. Only a handful of EBV-negative AITL cases with EBV-negative RS-like B-cells have been reported over the last decade. We present a rare case of EBV-negative AITL with chylous ascites and chylothorax. Microscopic and immunohistochemical analysis revealed the presence of EBV-negative Reed-Sternberg-like B-cells in the tumor.
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67
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Srinivasan A, Apostolov R, Leong A, Johnson D. Atraumatic chylous ascites: an unusual presentation of bladder cancer. BMJ Case Rep 2017; 2017:bcr-2016-219006. [PMID: 28473429 DOI: 10.1136/bcr-2016-219006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a case of bladder cancer presenting with atraumatic chylous ascites, which remains an extremely rare presentation of this condition. A previously well, elderly ex-smoker with no prior history of abdominal surgery was referred for investigation of progressive dyspnoea, increasing peripheral oedema and new-onset ascites, on a background of long-standing alcohol consumption (four standard drinks daily). Liver biochemistry and coagulation profile were normal apart from marked hypoalbuminaemia. Doppler ultrasound of the liver demonstrated normal echotexture and patent vasculature. Abdominal paracentesis yielded 8 L of milk-coloured, triglyceride-rich fluid with abundant malignant cells. Urine cytology demonstrated malignant transitional cells, with radiological evidence of a large enhancing bladder mass, with evidence of adjacent lymphadenopathy and omental involvement. A diagnosis of metastatic stage IV transitional cell bladder cancer was made. The patient declined palliative chemotherapy and passed away 2 months after their initial presentation.
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Affiliation(s)
| | - Ross Apostolov
- Department of Gastroenterology, Austin Health, Melbourne, Australia
| | - Amanda Leong
- Department of Gastroenterology, Austin Health, Melbourne, Australia
| | - Douglas Johnson
- Department of General Medicine, Austin Health, Heidelberg, Australia
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68
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Zalles-Vidal CR, Peñarrieta-Daher A, Ibarra-Rios D, Fernandez-Portilla E, Bracho-Blachet E. Chylous Ascites in a Newborn with Gastroschisis. Case Report. J Neonatal Surg 2017; 6:16. [PMID: 28083502 PMCID: PMC5224749 DOI: 10.21699/jns.v6i1.428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/19/2016] [Indexed: 11/11/2022] Open
Abstract
Chylous ascites is a rare disease, only two cases associated with gastroschisis have been published. We report a case treated conservatively with total parenteral nutrition (TPN) and octreotide. We reviewed the literature about management options for the chylous ascites.
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Affiliation(s)
- Cristian Ruben Zalles-Vidal
- Department of Pediatric Surgery (Neonatal Surgery Service), Hospital Infantil de México Federico Gomez, México City
| | - Alejandro Peñarrieta-Daher
- Department of Pediatric Surgery (Neonatal Surgery Service), Hospital Infantil de México Federico Gomez, México City
| | - Daniel Ibarra-Rios
- Department of Neonatology, Hospital Infantil de México Federico Gomez, México City
| | - Emilio Fernandez-Portilla
- Department of Pediatric Surgery (Neonatal Surgery Service), Hospital Infantil de México Federico Gomez, México City
| | - Eduardo Bracho-Blachet
- Department of Pediatric Surgery (Neonatal Surgery Service), Hospital Infantil de México Federico Gomez, México City
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69
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Idiopathic chylous ascites simulating acute appendicitis: A case report and literature review. Int J Surg Case Rep 2016; 29:189-192. [PMID: 27866036 PMCID: PMC5121156 DOI: 10.1016/j.ijscr.2016.10.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/25/2016] [Accepted: 10/25/2016] [Indexed: 12/23/2022] Open
Abstract
A rare case of idiopathic chylous ascites in a young female is reported. The management and outcome with long term follow up were discussed. The variable nature of presentation of chylous ascites necessitates high index of suspicion. Diagnosis predominately requires abdominal paracentesis and triglyceride levels in the ascetic fluid obtained. Management of idiopathic chylous ascites is mostly conservative, once the diagnosis is established. The treatment may include low fat diet and occasional somatostatin use. Further research is mandatory as there is a significant rise in reported cases with no standardized guidelines for management.
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70
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Renal Thrombotic Microangiopathy, Podocytopathy, and Chylous Ascites: A Hard-Nosed Diagnosis. Am J Med 2016; 129:e227-31. [PMID: 27154780 DOI: 10.1016/j.amjmed.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 04/01/2016] [Accepted: 04/05/2016] [Indexed: 11/24/2022]
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71
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Lin CT, Chen TM. Chylous ascites after pedicled transverse rectus abdominis myocutaneous flap harvest. Acta Chir Belg 2016; 116:256-259. [PMID: 27537823 DOI: 10.1080/00015458.2016.1147245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chylous ascites is a rare clinical condition that occurs as a consequence of disruption of the abdominal lymphatics. Here, we present the case of a 58-year-old woman with sustained chylous ascites after pedicled transverse rectus abdominis myocutaneous (TRAM) flap harvest. The chylous ascites did not decrease despite conservative therapy. For the diagnosis and localization of the chyle leakage, lymphangiography with lipiodol delivery was performed. Chylous drainage continued in a decreasing manner for the next 4 d because lipiodol accumulated to the point of leakage outside the lymphatic vessel causing a regional inflammatory reaction and obstructing the lymphatic vessels. To our knowledge, there is no case of chylous ascites related to pedicled TRAM flap harvest that has been reported in the English literature, in which the chyle leakage spontaneously resolved after lymphangiography.
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72
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Abstract
This case report describes chylous ascites associated with a CHD in a 4-month-old infant. Although atraumatic chylous ascites are a rare clinical finding, the recognition and treatment of chylous ascites influence the timing of cardiac surgery.
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73
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Akama Y, Shimizu T, Fujita I, Kanazawa Y, Kakinuma D, Kanno H, Yamagishi A, Arai H, Uchida E. Chylous ascites associated with intestinal obstruction from volvulus due to Petersen's hernia: report of a case. Surg Case Rep 2016; 2:77. [PMID: 27468960 PMCID: PMC4965361 DOI: 10.1186/s40792-016-0207-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/23/2016] [Indexed: 12/23/2022] Open
Abstract
Background Chylous ascites is an uncommon finding which is usually associated with recent abdominal/oncologic or retroperitoneal surgery. It is not usually seen in cases of acute obstruction. Case presentation A patient who had previously undergone a laparoscopy-assisted distal gastrectomy with Roux-en-Y reconstruction for early gastric cancer presented with acute abdominal pain and epigastric fullness. Computed tomography suggested small bowel obstruction due to volvulus. We were able to reduce the volvulus and close a Petersen’s hernia without resecting the bowel; a large amount of chylous ascites was an incidental finding. Conclusions We present a case of chylous ascites occurring in a setting of small bowel obstruction due to Petersen’s hernia, 3 years after successful distal gastrectomy for early gastric cancer, with no evidence of tumor recurrence.
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Affiliation(s)
- Yuichi Akama
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan.
| | - Tetsuya Shimizu
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan
| | - Itsuo Fujita
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan
| | - Yoshikazu Kanazawa
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan
| | - Daisuke Kakinuma
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan
| | - Hitoshi Kanno
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan
| | - Aya Yamagishi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan
| | - Hiroki Arai
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan
| | - Eiji Uchida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, Japan
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74
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Burleson SL, Wang HE. Turbid Peritoneal Fluid. West J Emerg Med 2016; 17:189-90. [PMID: 26973749 PMCID: PMC4786243 DOI: 10.5811/westjem.2016.1.29444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 12/31/2015] [Accepted: 01/05/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Samuel L Burleson
- University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama
| | - Henry E Wang
- University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama
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75
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Arnold CE, Taylor T, Chaffin MK, Schott HC, Caron JP. Nephrectomy Via Ventral Median Celiotomy in Equids. Vet Surg 2015; 42:275-9. [DOI: 10.1111/j.1532-950x.2013.01095.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 11/01/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Carolyn E. Arnold
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Texas A&M University; College Station, TX
| | - Tex Taylor
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Texas A&M University; College Station, TX
| | - M. Keith Chaffin
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Texas A&M University; College Station, TX
| | - Harold C. Schott
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine, Michigan State University; East Lansing, MI
| | - John P. Caron
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine, Michigan State University; East Lansing, MI
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76
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Yang AL, Baron TH, Hart PA. An Uncommon Cause of Peripancreatic Fluid. Gastroenterology 2015; 149:e3-4. [PMID: 26319035 DOI: 10.1053/j.gastro.2015.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 01/24/2015] [Accepted: 02/10/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Allison L Yang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota; Division of Gastroenterology, University of North Carolina, Chapel Hill, North Carolina
| | - Phil A Hart
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota; Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University, Columbus, Ohio
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77
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Eliason K, Adler DG. Endoscopic ultrasound-guided transmural drainage of infected pancreatic necrosis developing 2 years after acute pancreatitis. Endosc Ultrasound 2015; 4:260-5. [PMID: 26374588 PMCID: PMC4568642 DOI: 10.4103/2303-9027.163020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This is a case report of endoscopic ultrasound guided transmural drainage of a large infected pancreatic necrosis. The infected necrosis was treated by placement of a fully covered metal stent with subsequent endoscopic necrosectomy to remove solid debris. The case is notable for the fact that the patient developed infection of a long-standing and previously stable area of walled-off pancreatic necrosis 2 years after it formed. We believe this is the longest time ever reported between necrotizing pancreatitis and the development of infected pancreatic necrosis.
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Affiliation(s)
| | - Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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78
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Abstract
We provide a practical approach to the complex management problem of chyle leaks that occur after surgical procedures or trauma, or when they occur spontaneously in association with malignancies. The volume of chyle loss causes significant problems due to loss of fluid, electrolytes, proteins, and lymphocytes, causing deleterious effects on wound healing and immunity. Enteral feeding is not always possible as long chain fatty acids are absorbed through the intestinal lacteals, the original source of chyle. Regular diets increase the leak and delay healing. Nutritional support involves coordinated care between healthcare providers to provide a combination of various modalities, including nil by mouth, parenteral nutrition, enteral feeding with formula modifications, and oral diet.
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79
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Kaya C, Yazıcı P, Kartal K, Bozkurt E, Mihmanlı M. A rare cause of acute abdomen: Chylous ascites. Turk J Surg 2015; 33:123-125. [PMID: 28740965 DOI: 10.5152/ucd.2015.2920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/02/2014] [Indexed: 12/23/2022]
Abstract
Chylous ascites, defined as a lipid-rich fluid accumulation in the peritoneal cavity, is a rare pathology of the lymphatic system and is a very rare cause of acute abdomen. It is generally associated with diseases such as cancer, cirrhosis, inflammatory diseases, surgery, or trauma. In this study, we report a patient with chylous ascites, which mimics acute appendicitis. Diagnosis and treatment procedures were discussed.
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Affiliation(s)
- Cemal Kaya
- Clinic of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Pınar Yazıcı
- Clinic of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Kinyas Kartal
- Clinic of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Emre Bozkurt
- Clinic of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Mihmanlı
- Clinic of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
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80
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Hsiao CH, Yu CC, Hsieh TY, Kao YL, Wang SC, Chen WJ, Chen SL. Chylous ascites as a complication of nephroureterectomy. UROLOGICAL SCIENCE 2015. [DOI: 10.1016/j.urols.2015.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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81
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Chylous ascites following retroperitoneal lymphadenectomy in gynecologic malignancies: Incidence, risk factors and management. Int J Surg 2015; 16:88-93. [DOI: 10.1016/j.ijsu.2015.02.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 01/28/2015] [Accepted: 02/26/2015] [Indexed: 12/23/2022]
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82
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Lu J, Wei ZQ, Huang CM, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M. Small-volume chylous ascites after laparoscopic radical gastrectomy for gastric cancer: Results from a large population-based sample. World J Gastroenterol 2015; 21:2425-2432. [PMID: 25741151 PMCID: PMC4342920 DOI: 10.3748/wjg.v21.i8.2425] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/02/2014] [Accepted: 10/21/2014] [Indexed: 02/07/2023] Open
Abstract
AIM: To report the incidence and potential risk factors of small-volume chylous ascites (SVCA) following laparoscopic radical gastrectomy (LAG).
METHODS: A total of 1366 consecutive gastric cancer patients who underwent LAG from January 2008 to June 2011 were enrolled in this study. We analyzed the patients based on the presence or absence of SVCA.
RESULTS: SVCA was detected in 57 (4.17%) patients, as determined by the small-volume drainage (range, 30-100 mL/24 h) of triglyceride-rich fluid. Both univariate and multivariate analyses revealed that the total number of resected lymph nodes (LNs), No. 8 or No. 9 LN metastasis and N stage were independent risk factors for SVCA following LAG (P < 0.05). Regarding hospital stay, there was a significant difference between the groups with and without SVCA (P < 0.001). The 3-year disease-free and overall survival rates of the patients with SVCA were 47.4% and 56.1%, respectively, which were similar to those of the patients without SVCA (P > 0.05).
CONCLUSION: SVCA following LAG developed significantly more frequently in the patients with ≥ 32 harvested LNs, ≥ 3 metastatic LNs, or No. 8 or No. 9 LN metastasis. SVCA, which was successfully treated with conservative management, was associated with a prolonged hospital stay but was not associated with the prognosis.
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83
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Lott K, Mansfield C, Abraham LA. Acute chylous peritonitis associated with acute pancreatitis in a Staffordshire bull terrier. N Z Vet J 2014; 63:125-6. [PMID: 25105758 DOI: 10.1080/00480169.2014.948093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- K Lott
- a University of Melbourne Veterinary Teaching Hospital , 250 Princes Highway, Werribee VIC 3030 , Australia
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84
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Four Cases of Chylous Ascites following Robotic Gynecologic Oncological Surgery. Case Rep Obstet Gynecol 2014; 2014:953965. [PMID: 24716036 PMCID: PMC3970362 DOI: 10.1155/2014/953965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 01/20/2014] [Indexed: 12/23/2022] Open
Abstract
Chylous ascites is an uncommon form of ascites characterized by milky-appearing fluid caused by blocked or disrupted lymph flow through chyle-transporting vessels. The most common causes of chylous ascites are therapeutic interventions and trauma. In this report, we present four cases of chylous ascites following robot-assisted surgery for endometrial staging and the treatment strategies that we used. After retroperitoneal lymph node dissection, leaving a drain is very useful in diagnosing chylous ascites and observing its resolution; furthermore, the use of octreotide in conjunction with TPN appears to be an efficient treatment modality for chylous ascites and should be considered before any invasive intervention.
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85
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Ünlüsoy Aksu A, Demirtaş Z, Eğritaş Gürkan Ö, Dalgıç B, Sözen H, Dalgıç A. Chylous ascites after a living-donor liver graft, effectively treated in a child with octreotide. EXP CLIN TRANSPLANT 2014; 12 Suppl 1:173-174. [PMID: 24635821 DOI: 10.6002/ect.25liver.p48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Chylous ascites after a liver transplant is a rare complication of surgery. We report a 11-month-old girl with biliary atresia who was presented with chylous ascites after a liver transplant. On the seventh day after surgery, while being fed, chylous ascites was observed. Besides fasting and diuretics, total parenteral nutrition and somatostatin analogue (octreotide) were initiated. Chylous ascites resolved in 3 weeks. Abdominal distention recurred 1 week later; fasting and total parenteral nutrition, combined with octreotide, were administered again for 2 more weeks. Thereafter, enteral feeding was started without any complications.
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Affiliation(s)
- Aysel Ünlüsoy Aksu
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Gazi University, Ankara, Turkey
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86
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Lanneaux J, Davourie-Salandre A, Tudorache E, Stoica I, Aoun B, Ulinski T. Chyloperitoneum in pediatric peritoneal dialysis: rapid remission after introduction of medium-chain triglyceride-based formula. Perit Dial Int 2014; 33:333-4. [PMID: 23660612 DOI: 10.3747/pdi.2012.00181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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87
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Chylous Ascites: Evaluation and Management. ISRN HEPATOLOGY 2014; 2014:240473. [PMID: 27335837 PMCID: PMC4890871 DOI: 10.1155/2014/240473] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 12/19/2013] [Indexed: 02/07/2023]
Abstract
Chylous ascites refers to the accumulation of lipid-rich lymph in the peritoneal cavity due to disruption of the lymphatic system secondary to traumatic injury or obstruction. Worldwide, abdominal malignancy, cirrhosis, and tuberculosis are the commonest causes of CA in adults, the latter being most prevalent in developing countries, whereas congenital abnormalities of the lymphatic system and trauma are commonest in children. The presence of a milky, creamy appearing ascitic fluid with triglyceride content above 200 mg/dL is diagnostic, and, in the majority of cases, unless there is a strong suspicion of malignancy, further investigations are not required in patients with cirrhosis. If an underlying cause is identified, targeted therapy is possible, but most cases will be treated conservatively, with dietary support including high-protein and low-fat diets supplemented with medium-chain triglycerides, therapeutic paracentesis, total parenteral nutrition, and somatostatins. Rarely, resistant cases have been treated by transjugular intrahepatic portosystemic shunt, surgical exploration, or peritoneovenous shunt.
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88
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Lee YD, Lee YH, Choi HS. Chylous Ascites in a Patient with Sepsis Caused by Bilateral Pneumonia. Korean J Crit Care Med 2014. [DOI: 10.4266/kjccm.2014.29.3.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Yong Dae Lee
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Young Hyun Lee
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Hye Sook Choi
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
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89
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Galketiya K, Davis I. Chylous ascites complicating anterior resection for colorectal cancer. ANZ J Surg 2013; 83:391-2. [PMID: 23614888 DOI: 10.1111/ans.12122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Kamal Galketiya
- Department of Surgery, Canberra Hospital, Canberra, Australian Capital Territory, Australia
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90
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A rare case of systemic lupus erythematosus with chylous ascites and chylothorax. Case Rep Rheumatol 2013; 2013:797696. [PMID: 23864976 PMCID: PMC3705745 DOI: 10.1155/2013/797696] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 06/10/2013] [Indexed: 11/21/2022] Open
Abstract
During the course of the disease a patient with systemic lupus erythematosus (SLE) may develop inflammation of one or more serous membranes, resulting in pleural, peritoneal, or pericardial effusion. Chylous ascites and chylothorax have rarely been described in patients with SLE. Therefore, in parallel with the analysis of blood samples, detailed analysis of the effusions should be carried out. Supportive measures are often needed to relieve the symptoms of chylothorax or chylous ascites together with the treatment of the primary disease. The available literature had reported just 4 cases of chylous ascites and/or chylothorax in association with SLE, and this patient presented here is one of the rare cases apart from the reported ones.
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91
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Koh YX, Chng JK, Tan HC, Chung YF. Intestinal torsion causing chylous ascites: a rare occurrence. Singapore Med J 2013; 54:e88-90. [DOI: 10.11622/smedj.2013089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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92
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Chylous Ascites and Chylothorax as Presentation of a Systemic Progression of Discoid Lupus. J Clin Rheumatol 2013; 19:87-9. [DOI: 10.1097/rhu.0b013e3182847260] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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93
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Moreira DDAR, Santos MM, Tannuri ACA, Tannuri U. Congenital chylous ascites: a report of a case treated with hemostatic cellulose and fibrin glue. J Pediatr Surg 2013; 48:e17-9. [PMID: 23414895 DOI: 10.1016/j.jpedsurg.2012.11.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 11/14/2012] [Accepted: 11/15/2012] [Indexed: 10/27/2022]
Abstract
We report a case of an infant with recurrent chylous ascites who was unresponsive to conventional medical treatment. An exploratory laparotomy revealed no macroscopically visible sites of lymph leakage that could be ligated. Lymph exudation was noted in areas near the subhepatic recess and in the lesser sac surrounding the pancreas, which was not amenable to suture. The treatment consisted of the placement of a hemostatic mesh composed of oxidized cellulose (Surgicel) on these areas, with a thin layer of fibrinogen/thrombin glue over the mesh (Tissucol). The cellulose mesh allowed for greater adhesion of the fibrin glue to the diseased tissues. The patient had no recurrence of ascites and is currently 20 months old, with good weight-height gain, and free of ascites.
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Affiliation(s)
- Daniel de Albuquerque Rangel Moreira
- Pediatric Surgery Division, Pediatric Liver Transplantation Unit, Laboratory of Research in Pediatric Surgery (LIM 30), University of Sao Paulo Medical School, Sao Paulo, Brazil
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94
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Chronic Pancreatitis Associated with Chylous Ascites Simulating Liver Cirrhosis. Case Rep Surg 2013; 2013:763561. [PMID: 24363949 PMCID: PMC3865637 DOI: 10.1155/2013/763561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 10/09/2013] [Indexed: 11/17/2022] Open
Abstract
Purpose. Ascites, esophageal varicose veins, and acute digestive bleeding are unusual in the clinical presentation of chronic pancreatitis; however, these symptoms are frequently observed in patients with liver cirrhosis. Moreover, it is unlikely to observe chylous ascites in both presentations. Method. We report a patient who presented with chronic pancreatitis with splenic vein thrombosis, necrosis of the pancreatic neck and tail, esophageal varicose veins with previous bleeding, and chylous ascites. After partial pancreatectomy, his treatment was based on low-fat oral diet with medium-chain triglycerides with remarkable resolution of the chylous ascites. After 3 years, he presented with decompensated chronic pancreatitis and underwent plexus alcoholization and biliary-enteric deviation with an unremarkable postoperative course. Conclusion. Ascites is rarely associated with chronic pancreatitis, and chylous ascites is even rarer. The treatment of atraumatic chylous ascites is based on resolution of the obstructive causes and should include drainage and a low-fat diet with medium-chain triglycerides.
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95
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Tewari N, Bhalla A, Iftikhar S. Chylous ascites: Why exercise is bad for you. Int J Surg Case Rep 2012; 4:118-20. [PMID: 23174523 DOI: 10.1016/j.ijscr.2012.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 10/15/2012] [Accepted: 10/22/2012] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The development of chylous ascites is usually associated with trauma, iatrogenic or otherwise. Blunt abdominal trauma producing hyperextension or hyperflexion may cause disruption to lymphatic vessels causing chylous ascites. PRESENTATION OF CASE This report describes the case of a 38-year-old gentleman who presented to the emergency department with severe abdominal pain after completing a triathlon. As the patient was in severe pain, an abdominal CT was performed which demonstrated a possible mid gut volvulus. Subsequent laparotomy noted a significant volume of intra-abdominal chyle with no other abnormalities. DISCUSSION This is the first report of chylous ascites occurring without associated abdominal pathology after a period of strenuous exercise. CONCLUSION Chylous ascites can occur as a result of hyperreflexion and hyperextension injuries sustained during strenuous exercise.
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Affiliation(s)
- N Tewari
- Royal Derby Hospitals NHS Foundation Trust, United Kingdom.
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96
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Yilmaz M, Akbulut S, Isik B, Ara C, Ozdemir F, Aydin C, Kayaalp C, Yilmaz S. Chylous ascites after liver transplantation: incidence and risk factors. Liver Transpl 2012; 18:1046-52. [PMID: 22639428 DOI: 10.1002/lt.23476] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In this study, we evaluated the diagnosis, epidemiology, risk factors, and treatment of chylous ascites developing after liver transplantation (LT). Between 2002 and 2011, LT was performed 693 times in 631 patients at our clinic. One-hundred fifteen of these patients were excluded for reasons such as retransplantation, early postoperative mortality, and insufficient data. Chylous ascites developed after LT (mean ± SD = 8.0 ± 3.2 days, range = 5-17 days) in 24 of the 516 patients included in this study. Using univariate and multivariate analyses, we examined whether the following were risk factors for developing chylous ascites: age, sex, body mass index, graft-to-recipient weight ratio, Model for End-Stage Liver Disease score, vena cava cross-clamping time, total operation time, Child-Pugh classification, sodium level, portal vein thrombosis or ascites before transplantation, donor type, albumin level, and perihepatic dissection technique [LigaSure vessel sealing system (LVSS) versus conventional suture ligation]. According to a univariate analysis, a low albumin level (P = 0.04), the presence of ascites before transplantation (P = 0.03), and the use of LVSS for perihepatic dissection (P < 0.01) were risk factors for developing chylous ascites. According to a multivariate Cox proportional hazards model, the presence of pretransplant ascites [P = 0.04, hazard ratio (HR) = 2.8, 95% confidence interval (CI) = 1.1-13.5] and the use of LVSS for perihepatic dissection (P = 0.01, HR = 5.4, 95% CI = 1.5-34.4) were independent risk factors. In conclusion, the presence of preoperative ascites and the use of LVSS for perihepatic dissection are independent risk factors for the formation of chylous ascites. To our knowledge, this study is the most extensive examination of the development of chylous ascites. Nevertheless, our results should be supported by new prospective trials.
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Affiliation(s)
- Mehmet Yilmaz
- Division of Liver Transplantation, Department of Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey.
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97
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Abstract
Chylous ascites is rare in clinical practice. It is characterized by milky-appearing peritoneal fluid with a triglycerides concentration of >1.25 mmol/l (110 mg/dl). Its pathophysiology is related to a disruption in the normal lymphatic flow. It is more common after trauma (including post surgery), neoplasia or atypical infections such as tuberculosis or filariasis. Other rare medical causes have been reported. The treatment is supportive and focused on correction of the underlying pathology. We report here the first case of chylous ascites caused by giant liver hemangioma and discuss the management of this condition.
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Affiliation(s)
- Darius L Lazarus
- Department of Medicine, McGill University, Montreal, Que., Canada
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98
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Abstract
Ascites is the pathologic accumulation of fluid in the peritoneum. It is the most common complication of cirrhosis, with a prevalence of approximately 10%. Over a 10-year period, 50% of patients with previously compensated cirrhosis are expected to develop ascites. As a marker of hepatic decompensation, ascites is associated with a poor prognosis, with only a 56% survival 3 years after onset. In addition, morbidity is increased because of the risk of additional complications, such as spontaneous bacterial peritonitis and hepatorenal syndrome. Understanding the pathophysiology of ascites is essential for its proper management.
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Park DE, Chae KM. Chylous ascites caused by acute pancreatitis with portal vein thrombosis. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81 Suppl 1:S64-8. [PMID: 22319743 PMCID: PMC3267070 DOI: 10.4174/jkss.2011.81.suppl1.s64] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 07/18/2011] [Accepted: 07/28/2011] [Indexed: 12/13/2022]
Abstract
Chylous ascites is defined as the accumulation of chyle in the peritoneum due to obstruction or rupture of the peritoneal or retroperitoneal lymphatic glands. Chylous ascites that arises from acute pancreatitis with portal vein thrombosis is very rare. We report here on a case of chylous ascite that was caused by acute pancreatitis with portal vein thrombosis, in which the patient showed an impressive response to conservative therapy with total parenteral nutrition and octerotide. We also review the relevant literature about chylous ascites with particular reference to the management of this rare disease.
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Affiliation(s)
- Dong Eun Park
- Department of Surgery, Wonkwang University Hospital, Wonkang University College of Medicine, Iksan, Korea
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