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Wabada S, Ibrahim HA, Dada BJ, Zanna AU, Muhammed A, Mustapha B. Management of chylous ascites with surgery and frusemide in a new born. Afr J Paediatr Surg 2022; 19:192-195. [PMID: 35775526 PMCID: PMC9290358 DOI: 10.4103/ajps.ajps_59_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chylous ascites is the accumulation of milky fat-rich chyle in the peritoneal cavity. It is a rare condition in children. Congenital malformations of the lymphatic vascular channel are the predominant cause in children. Diagnosis is often confirmed by paracentesis of the chylous ascitic fluid. Treatment is generally conservative except in rare refractory cases that surgery is required for closure of the leak site or excision of the lymphatic cyst. Here is a report on the management of chylous ascites in a 6-h-old girl presenting in acute respiratory distress with acute abdominal distention due rapid increase in chylous ascitic fluid volume that was managed with surgery and frusemide.
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Affiliation(s)
- Samuel Wabada
- Department of Surgery, Paediatric Surgery Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Halima Abubakar Ibrahim
- Department of Paediatrics, Neonatology Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Bisuma Joel Dada
- Department of Paediatrics, Neonatology Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Aisha Umaryyrah Zanna
- Department of Surgery, Paediatric Surgery Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Abdulmajeed Muhammed
- Department of Surgery, Paediatric Surgery Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Bello Mustapha
- Department of Paediatrics, Neonatology Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
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Risk factors of chylous ascites and its relationship with long-term prognosis in laparoscopic D3 lymphadenectomy for right colon cancer. Langenbecks Arch Surg 2022; 407:2453-2462. [PMID: 35589848 DOI: 10.1007/s00423-022-02527-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chylous ascites (CA) after laparoscopic D3 lymphadenectomy for right colon cancer is not rare. However, the risk factors for CA have not been fully explored. Few studies have investigated the effect of CA on long-term prognosis. METHODS The clinical data of patients with right colon cancer who underwent laparoscopic D3 lymphadenectomy in five centers from January 2013 to December 2018 were retrospectively collected. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with CA. Then, the long-term prognosis of patients with and without CA was compared by propensity score matching and Kaplan-Meier survival analysis. RESULTS The incidence of CA was 4.4% (48/1090). Pathological T stage (p = 0.025), dissection along the left side of the superior mesenteric artery (p < 0.001) and the number of retrieved lymph nodes (p < 0.001) were independent risk factors for CA. After propensity score matching, 48 patients in the CA group and 353 patients in the non-CA group were enrolled. Kaplan-Meier survival analysis indicated that CA was not associated with overall survival (p = 0.454) and disease-free survival (p = 0.163). In patients with stage III right colon cancer, there were no significant differences in overall survival (p = 0.501) and disease-free survival (p = 0.254). CONCLUSIONS Pathological T stage, number of retrieved lymph nodes, and left side dissection along the superior mesenteric artery were independent risk factors for CA after laparoscopic D3 lymphadenectomy. CA does not impair the oncological outcomes of patients.
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Percutaneous embolization of hepatic lymphorrhea post-hepatectomy. Radiol Case Rep 2022; 17:549-552. [PMID: 34987682 PMCID: PMC8693431 DOI: 10.1016/j.radcr.2021.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 11/28/2021] [Indexed: 11/23/2022] Open
Abstract
Abdominal effusion due to hepatic lymphorrhea post-hepatectomy is an extremely rare and complex complication in clinical practice. No standard treatment method has been established for this condition to date. We report a case of complicated intra-abdominal lymphatic leakage in a patient following hepatectomy to treat hepatocellular carcinoma. The patient underwent percutaneous embolization of the hilar hepatic lymphatic system, combined with intensive medical treatment. Percutaneous embolization represents a safe and effective method that should be considered as a first-line treatment for this complication.
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Mas E, Borrelli O, Broekaert I, de-Carpi JM, Dolinsek J, Miele E, Pienar C, Koninckx CR, Thomassen RA, Thomson M, Tzivinikos C, Benninga MA. Drugs in Focus: Octreotide Use in Children With Gastrointestinal Disorders. J Pediatr Gastroenterol Nutr 2022; 74:1-6. [PMID: 34508049 DOI: 10.1097/mpg.0000000000003294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT Octreotide, a somatostatin analogue, has been used for more than 20 years in children with gastrointestinal bleeding, chylothorax or chylous ascites, intestinal lymphangiectasia, pancreatitis, intestinal dysmotility, and severe diarrhoea; however, until now, there is a lack of randomised clinical trials evaluating the efficacy of this compound in childhood. Hence, we aimed to review the literature in order to determine the evidence of its use and safety in children, using PubMed from 2000 to 2021 with the search terms "octreotide" and "children" and "bleeding or chylous ascites or chylothorax or acute pancreatitis or lymphangiectasia or diarrhoea or intestinal dysmotility".
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Affiliation(s)
- Emmanuel Mas
- Unité de Gastroentérologie, Hépatologie, Nutrition, Diabétologie et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, CHU de Toulouse; IRSD, Université de Toulouse, INSERM, INRAE, ENVT, UPS, Toulouse, France
| | - Osvaldo Borrelli
- Department of Paediatric Gastroenterology, Neurogastroenterology and Motility Unit, Great Ormond Street Hospital, London, UK
| | - Ilse Broekaert
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - J Martin de-Carpi
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Jernej Dolinsek
- Department of Paediatrics, University Medical Centre Maribor, Maribor, Slovenia
| | - Erasmo Miele
- Department of Translational Medical Science, Section of Paediatrics, University of Naples "Federico II", Naples Italy
| | - Corina Pienar
- Department of Paediatrics, 2 Paediatric Clinic, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - C Ribes Koninckx
- Paediatric Gastroenterology, La Fe University Hospital, Valencia, Spain
| | - Ruth-Anne Thomassen
- Department of Paediatric Medicine, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Mike Thomson
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Christo Tzivinikos
- Department of Paediatric Gastroenterology, Al Jalila Children's Specialty Hospital, Dubai, UAE
| | - Marc A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Miserachs M, Lurz E, Levman A, Ghanekar A, Cattral M, Ng V, Grant D, Avitzur Y. Diagnosis, Outcome, and Management of Chylous Ascites Following Pediatric Liver Transplantation. Liver Transpl 2019; 25:1387-1396. [PMID: 31301267 PMCID: PMC7165704 DOI: 10.1002/lt.25604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/25/2019] [Indexed: 12/13/2022]
Abstract
Data on postoperative chylous ascites (CA) after pediatric liver transplantation (LT) are scarce. This retrospective study was conducted to identify the incidence, risk factors, management, and outcomes of postoperative CA in a large single-center pediatric LT cohort (2000-2016). The study cohort comprised 317 LTs (153 living donors and 164 deceased donors) in 310 recipients with a median age of 2.7 years. The incidence of CA was 5.4% (n = 17), diagnosed after a median time of 10 days after LT. Compared with chylomicron detection in peritoneal fluid (the gold standard), a triglyceride cutoff value of 187 mg/dL in peritoneal fluid showed insufficient sensitivity (31%) for CA diagnosis. In univariate logistic regression analyses, ascites before LT, younger age, and lower weight, height, and height-for-age z score at LT were associated with CA. Symptomatic management of CA included peritoneal drain (100%) and diuretics (76%). Therapeutic interventions included very low-fat or medium-chain triglyceride-rich diets (94%) and intravenous octreotide (6%), leading to CA resolution in all patients. CA was associated with prolonged hospital length of stay (LOS; 40 days in the CA group versus 24 days in the non-CA group; P = 0.001) but not with reduced patient or graft survival rates after a median follow-up time of 14 years. In conclusion, CA in the pediatric LT recipient is a relatively uncommon complication associated with increased hospital LOS and morbidity. Measurement of chylomicrons is recommended in patients with ascites that is more severe or persistent than expected. Dietary interventions are effective in most patients.
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Affiliation(s)
- Mar Miserachs
- Transplant and Regenerative Medicine CentreHospital for Sick ChildrenTorontoOntarioCanada
- Division of Pediatric Gastroenterology, Hepatology and NutritionHospital for Sick Children, University of TorontoTorontoOntarioCanada
- Universitat Autònoma de BarcelonaBellaterraSpain
| | - Eberhard Lurz
- Transplant and Regenerative Medicine CentreHospital for Sick ChildrenTorontoOntarioCanada
- Division of Pediatric Gastroenterology, Hepatology and Nutritionvon Haunersches Kinderspitak, Ludwig Maximillians University MunichMunichGermany
| | - Aviva Levman
- Transplant and Regenerative Medicine CentreHospital for Sick ChildrenTorontoOntarioCanada
| | - Anand Ghanekar
- Multi‐Organ Transplant ProgramUniversity Health NetworkTorontoOntarioCanada
- Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Mark Cattral
- Multi‐Organ Transplant ProgramUniversity Health NetworkTorontoOntarioCanada
- Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Vicky Ng
- Transplant and Regenerative Medicine CentreHospital for Sick ChildrenTorontoOntarioCanada
- Division of Pediatric Gastroenterology, Hepatology and NutritionHospital for Sick Children, University of TorontoTorontoOntarioCanada
| | - David Grant
- Multi‐Organ Transplant ProgramUniversity Health NetworkTorontoOntarioCanada
- Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Yaron Avitzur
- Transplant and Regenerative Medicine CentreHospital for Sick ChildrenTorontoOntarioCanada
- Division of Pediatric Gastroenterology, Hepatology and NutritionHospital for Sick Children, University of TorontoTorontoOntarioCanada
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Combined Chylothorax and Chylous Ascites Complicating Liver Transplantation: A Report of a Case and Review of the Literature. Case Rep Transplant 2019; 2019:9089317. [PMID: 31428509 PMCID: PMC6679892 DOI: 10.1155/2019/9089317] [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: 03/29/2019] [Accepted: 07/04/2019] [Indexed: 12/03/2022] Open
Abstract
Chyle leaks may occur as a result of surgical intervention. Chyloperitoneum, or chylous ascites after liver transplantation, is rare and the development of chylothorax after abdominal surgery is even more rare. With increasingly aggressive surgical resections, particularly in the retroperitoneum, the incidence of chyle leaks is expected to increase in the future. Here we present a unique case of a combined chylothorax and chyloperitoneum following liver transplantation successfully managed conservatively. Risk factors for chylous ascites include para-aortic manipulation, extensive retroperitoneal dissection, use of a Ligasure device, and early enteral feeding as well as early enteral feeding. The clinical presentation is typically insidious and may include painless abdominal distension. Diagnosis can be made by noting characteristic milky white drainage which on laboratory examination has a total fluid triglyceride level >110 mg/dl, an ascites/serum triglyceride ratio of >1 and a leukocyte count in fluid >1000/uL with a lymphocyte predominance. Chyle leaks may lead to significant morbidity and mortality. Numerous management options exist, with conservative nonoperative measurements leading to the most consistent and successful outcomes. This includes a step-up approach beginning with dietary modifications to a low-fat or medium chain triglyceride diet followed by nil per os with addition of total parenteral nutrition and somatostatin analogues such as octreotide. Rarely do patients require more invasive treatment. Early recognition and appropriate management are imperative to mitigate this complication.
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