Chylothorax secondary to a pleuroperitoneal communication and chylous ascites after pancreatic resection

Embryological, anatomical and clinical considerations on pleuroperitoneal communication

The pleural and peritoneal cavity share many related features due to their common celomic origin. Normally these two spaces are completely separated with the development of the diaphragm. Defects in diaphragm morphogenesis may result in congenital diaphragmatic hernias, which is the most known form of communication between the pleural and peritoneal cavity. However, in several cases, findings of pleuroperitoneal communication (PPC) have been described in adults through an apparently intact diaphragm. In this comprehensive review we systematically evaluate clinical scenarios of this form of "unexpected" PPC as reported in the literature and focus on the possible mechanisms involved.

Transudative chylothorax in a liver cirrhosis patient: A case report

Chylothorax defines chyle in the pleural space, usually from defects in thoracic duct. Chylothoraces are usually exudative, as defined by light's criteria but in rare instances, chylothoraces can be transudative. The leading cause of non-traumatic chylothorax is malignancy, but a non-traumatic chylothorax can be a rare manifestation of liver cirrhosis. In this case report, we present a case of an 82-year-old male with a history of non-alcoholic liver cirrhosis requiring multiple paracenteses for chylous ascites in the past, who was found to have a transudative non-traumatic chylothorax. His chylothorax existed despite his ascites being resolved for over a year. We will describe this case of a transudative chylothorax associated with liver cirrhosis and discuss the common findings associated with chylothoraces.

Management of intractable post-adrenalectomy chylous ascites with microsurgical intra-abdominal lymphaticovenous anastomosis: A case report and literature review

Postoperative chylous ascites is a rare but highly morbid complication following thoracic or abdominal surgeries. Treatment options vary according to different clinical scenarios and facility equipment, but there is no standard guideline. We report a case of 46-year-old patient with chylous ascites after left laparoscopic adrenalectomy for metastatic lung cancer. The conservative treatments failed, included diet control, somatostatin provided and intranodal lymphangiography with lipiodol injection. Laparotomy was performed to explore the lymphatic vessel in the retroperitoneal area where a major and several small leaking holes were identified along the thoracic duct. The left gonadal vein was explored and transposed toward the lymphatic vessel. The lymphaticovenous anastomosis (LVA) was done using side (major leaking hole) to end (gonadal vein) fashion. The chylous leakage dropped from 2000 to 200 mL per day gradually within 10 days after LVA, and the patient was discharged uneventfully 30 days after the LVA surgery. He was followed at our clinic during the first postoperative 10 months without recurrent chylous ascites. This case demonstrates that microsurgical intervention with LVA to physiologically drain the chyle can be an optimal treatment for chylous ascites. A literature review was also conducted, and strategic management is proposed.