Establishment of a new strategy to correct the interference of chyle blood on the detection of hemoglobin and mean red blood cell hemoglobin concentration / 中华检验医学杂志

Objective:To establish a new strategy for rapid correction of the interference of chyle blood on hemoglobin (HGB) and related indexes by reticulocyte (RET) channel research parameters (HGB-O, MCHC-O) from automatic hematological analyzer.Methods:With the diagnostic experimental design, a total of 90 impatient samples were sequential picked from Fuwai Hospital, which had routine blood testing from June 1 to July 31, 2021. The selected samples were free of hemolysis, jaundice, chylo. The age of the patients was (49.2±5.7) years, with 47 males and 43 females. Three different contents(25, 50, 75 μl) of fat emulsion injection were used to replace plasma in equal amounts to prepare chyle blood samples with mild, medium and heavy degrees of average red blood cell hemoglobin concentration (MCHC). The research parameters (HGB-O, MCHC-O) obtained by the RET channel detection of the automatic blood analyzer were used as the corrected HGB and its related index values (RET method), and the original values (the detection values before adding fat emulsion) and the formula correction values were paired with t-test or Wilcoxon signed rank test, single factor analysis of variance or Kruskal-Wallis rank-sum test, Bland-Altman and correlation analysis to evaluate the correction effect of RET method.Results:There was no significant difference ( H=0.035, P=0.983; H=0.097, P=0.953; H=0.112, P=0.945) between the RET correction values of HGB (g/L) [104.0(83.8, 132.8), 109.0(87.78, 128.25), 104.0(87.8, 131.8)] and the original values [104.0(83.0, 133.0), 107.5(86.75, 129.25), 103.5(85.8, 131.3)] and the formula correction values [104.0(84.0, 133.8), 106.0(86.75, 131.25), 102.5(86.8, 131.3)] in the samples of chythemia with varying degrees of MCHC (g/L) elevation; meanwhile, the RET correction values [366.5(325.8, 341.5), 333.5(323.8, 340.0), 333.5(327.0, 341.25)] and the original values [336.0(324.8, 342.0), 333.0(323.5, 342.3), 332.0(326.75, 340.5)] and the formula correction values [333.5(323.5, 343.3), 331.0(321.0, 338.3), 329.5(325.25, 337.25)] were also not statistically significant ( H=0.049, P=0.976; H=3.149, P=0.207; H=0.883, P=0.643). The detection values of HGB and related indexes corrected by RET method were in good agreement with the original values [96.7% (29/30) of the points were within the 95% consistency limit], and the two were positively correlated (the correlation coefficients were all higher than 0.919, P<0.01). Conclusion:The RET method based on the research parameters of RET channel of automatic hematological analyzer can serve as a new strategy to correct the interference of chyle blood on the detection of HGB and related indexes.

A case report of bilateral chylous hemothorax presenting after laparoscopic renal pedicle lymphatic disconnection / 中华泌尿外科杂志

Laparoscopic renal pedicle lymphatic disconnection is the most effective method for treating chyluria that has failed to respond to conservative management. Chylous hemothorax is a rare clinical occurrence resulting from the anatomic abnormality. This paper reported a case, who was admitted with painless gross hematuria for 1 month and was diagnosed with left chylous hematuria. Laparoscopic left renal pedicle lymphatic disconnection was performed, and bilateral chylous hemothorax occurred after the operation. After conservative treatment such as bilateral closed thoracic drainage and blood transfusion support, the patient recovered well. After 2 months of follow-up, there was no obvious effusion in the bilateral thoracic cavity, and the chylous test of urine fluid was negative.

Interventional treatment of chylous leakage in 60 cases: a preliminary study / 中华放射学杂志

Objective:To evaluate the feasibility, safety, treatment outcome, and the individualized surgical procedure selection of the interventional treatments of chylous leakage.Methods:From July 2019 to January 2022, the clinical data of 60 consecutive patients with chylous leakage underwent interventional treatment were respectively analyzed. The cases included chylothorax ( n=37), chylous ascites ( n=10), chyluria ( n=4), chylothorax combined with chylous ascites ( n=5), chylothorax combined with chylopericardium ( n=2), and pelvic chylous effusion ( n=2). Conservative treatment was considered to have failed for all patients. The lymphangiography was firstly performed to detect chylous leakage, then an individualized procedure was selected according to the lymphangiography results. The treatment outcomes and complications were recorded, and follow-up was performed. Results:Lymphangiography was technically successful in 55 of 60 patients (91.7%), and no cisterna chyli and thoracic duct opacification was observed in 5 patients. The procedures for the patients included lymphangiography alone ( n=23), thoracic duct embolization ( n=23), thoracic duct disruption ( n=5), lymphatic embolization for pelvic chylous effusion ( n=4), and balloon plasty for thoracic duct ( n=5). Clinical success was achieved in 53 of 60 cases (88.3%). The complication rate was 8.3% (5/60), and all complications were minor. The median follow-up time was 11 months (range 0.5-30 months) for 56 patients, and 4 patients were lost to follow-up. There was one patient presenting the reoccurrence of symptom, and 8 patients died. Conclusions:The interventional treatment of chylous leakage is safe with good outcomes and low complication rate. Individualized treatment procedures based on the lymphangiography findings is feasible and with good curative effect.

Chylothorax and chylous ascites due to juvenile paracoccidioidomycosis: a case report

ABSTRACT Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by Paracoccidioides species. Chylothorax is a rare complication of PCM. A 16-year-old adolescent presented daily fever, lymphadenomegaly, sweating, weight loss, ventilatory-dependent pain, and dysphagia, which confirmed PCM. During treatment, the patient developed chylothorax and chylous ascites. Chronic inflammatory and fibrotic lymphadenopathy may obstruct lymphatic vessels, resulting in the extravasation of lymph into the abdomen or pleural cavities. Chylothorax is one of several complications of PCM and can lead to respiratory insufficiency, even in patients undergoing antifungal therapy.

Management and prognosis of congenital chylous ascites in 20 infants / 中华围产医学杂志

Objective:To summarize the perinatal management and prognosis of congenital chylous ascites (CCA).Methods:Clinical data of 20 infants diagnosed with CCA and treated in Guangdong Women and Children Hospital from June 2015 to November 2020 were retrospectively analyzed and described.Results:There were ten patients with isolated CCA and ten with non-isolated CCA. In isolated CCA cases, seven were cured after conservative treatment and three after postoperative conservative treatment following an ineffective surgery. Non-isolated CCA cases were complicated by intrauterine cytomegalovirus infection ( n=1), malrotation of intestine ( n=4) or bilateral chylothorax ( n=5). In addition to conservative treatment for CCA, non-isolated CCA patients also received antiviral therapy, Ladd's procedure or intrauterine/extrauterine closed thoracic drainage. Of eight patients who were firstly diagnosed with ascites before 30 gestational weeks, including four isolated and four non-isolated cases, only one underwent surgical intervention. During hospitalization, serious infections occurred in three infants with isolated CCA and two with non-isolated CCA, and were all controlled by anti-infection treatment. During a follow-up to median age of 29 months (15-82 months), none of the patients had any abnormalities except for the one with intrauterine cytomegalovirus infection who was deaf at the age of two. Conclusions:Conservative management is effective and the prognosis is generally good for most cases with isolated CCA. Treatment and prognosis of non-isolated CCA depend on its comorbidities. Gestational age at diagnosis may not be a prognostic predictor.

Isolated chylous ascites in preterm infants:a case report and literature review / 中华全科医师杂志

The clinical data of 5 cases of chylous ascites in preterm infants admitted in NICU of Peking Union Hospital from 2001 to 2021 were retrospectively analyzed. There were 3 boys and 2 girls with the gestational age of 29 +1 weeks, and birth weight of (1 122±323) g. No peritoneal effusion was found on prenatal ultrasound examination. All the five cases diagnosed with chylous ascites after the initiation of enteral nutrition on d4 to d10. All cases were resolved by conservative treatment, including fasting with total parenteral nutrition for 3 wks. The parenteral nutrition strategy was specified by high protein concentration (4 g·kg -1·d -1) and low lipid emulsion (2.0-2.5 g·kg -1·d -1). Formula containing 50% medium chain triglyceride or human milk was fed sequentially, and no feeding intolerance or abdominal distension were observed. All patients were discharged stable and followed up for 3-5 years,and no recurrence occurred. The PubMed and Wanfang database were searched for cases of chylous ascites in preterm infants, and 7 cases were reported in literature. Six cases were diagnosed by antenatal ultrasound between 21 and 23 weeks of gestational age. Three cases underwent radionuclide lymphoscintigraphy, and 2 of them demonstrated peritoneal lymphatic fistula or lymphatic dilatation. Five cases were treated with fasting plus intravenous infusion of octreotide. Three infants who failed to respond to conservative treatment underwent surgical treatment. Four cases were complicated with sepsis and needed intravenous antibiotic treatment.

Peritoneovenous shunt for treatment of refractory chylous ascites / 中华普通外科杂志

Objective:To evaluate peritoneovenous shunt for treatment of refractory chylous ascites.Methods:The clinical data of 40 patients with refractory chylous ascites treated by peritoneovenous shunt procedure at Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University from May 2008 to Aug 2020 were retrospectively analyzed.Results:Patients'postoperative weight [(57.8±13.2) kg] was significantly lower than that of preoperative weight [(65.9±13.1) kg]. Postoperative abdominal circumference significantly reduced [(82.0±9.8) cm vs. (94.3±10.8) cm]. Average postoperative 24-hour urine output was significantly higher than that before operation [2 250 (1 650, 3 300) ml vs. 750 (500, 1 000) ml]. Platelet count and fibrinogen decreased after operation; prothrombin time (PT) prolonged; the change of time of activated partial thromboplastin (APTT) was not statistically significant ( P=0.506). Postoperative aspartate aminotransferase (AST), urea, and creatinine decreased; whereas alanine aminotransferase (ALT) ( P=0.154), total protein ( P=0.350), and albumin ( P=0.113) remained unchanged. 35 patients got follow-up, 29 deceased. The survival time with tube was 16 (7,37) months; 6 cases survived, the survival time with tube was 28 (6,124) months. Conclusions:Peritoneovenous shunt is a palliative surgery improving the quality of life of patients with refractory chylous ascites.

Causas infrecuentes de ascitis: Reporte de 5 casos / Uncommon causes of ascites: Report of 5 cases

Introducción: La ascitis se define como la presencia de líquido en la cavidad peritoneal. La etiología más común la constituyen las enfermedades hepáticas que cursan con hipertensión portal, dentro de ellas la cirrosis hepática reportada en un 40 por ciento, a 5 años de seguimiento de los casos. Estudios previos muestran que la ascitis por enfermedad cirrótica hepática es entre un 80-85 por ciento, también la carcinomatosis se presenta en un 10 por ciento, y dentro de las causas más raras están la insuficiencia cardiaca y la tuberculosis peritoneal en un 3 por ciento, junto con la trombosis de la vena porta, sarcoidosis, tumores intraperitoneales, ascitis pancreática y la enteritis eosinofílica. Objetivo: Describir presentaciones clínicas infrecuentes como causa de ascitis en pacientes hospitalizados en el Hospital Clínico Quirúrgico Hermanos Ameijeiras. Presentación de casos: Se presentan cinco casos que ingresaron en el Hospital Hermanos Ameijeiras con diagnóstico de Ascitis: quilosa, hemorrágica, eosinofílica y coloide, con las patologías que los llevaron a esa manifestación clínica y una breve descripción de la misma. Conclusión: El análisis de las presentaciones clínicas de los casos, los hallazgos en los estudios imagenológicos y en los exámenes de laboratorio, así como los resultados anatomopatológicos permitieron el diagnóstico de las entidades causantes de ascitis atípicas en estos pacientes(AU)

Introduction: Ascites is defined as the presence of fluid in the peritoneal cavity. The most common etiology is liver diseases with portal hypertension; among them liver cirrhosis is reported in 40 percent of cases with 5-year follow-up. Previous studies demonstrate that ascites due to cirrhotic liver disease occurs in 80-85 percent of the cases, that carcinomatosis is also present in 10 percent, and also that among the rarest causes, heart failure and peritoneal tuberculosis are present in 3 percent of cases along with portal vein thrombosis, sarcoidosis, intraperitoneal tumors, pancreatic ascites and eosinophilic enteritis. Objective: To describe uncommon clinical presentations as cause of ascites in patients admitted to Hermanos Ameijeiras Clinical Surgical Hospital. Case presentation: Five cases of patients admitted to Hermanos Ameijeiras Clinical Surgical Hospital with the diagnosis of ascites: chylous, hemorrhagic, eosinophilic and colloid as well as the pathologies that led them to this clinical manifestation and a brief description of it are presented. Conclusion: The analysis of the clinical presentation of the cases, the findings in the imaging studies and laboratory tests and the anatomopathological results allowed the diagnosis of the entities causing atypical ascites in these patients(AU)

Abdomen agudo por ascitis quilosa secundaria a pancreatitis aguda: reporte de un caso

La ascitis quilosa (AQ) es una entidad rara, y puede manifestarse como una reacción peritoneal llamada peritonitis quilosa aguda (PQA). Presentamos el caso de un varón de 26 años, con cuadro abdominal agudo, por lo que es intervenido quirúrgicamente, encontrándose líquido lechoso turbio, en cavidad abdominal, realizándose una apendicectomía profiláctica, aspiración y lavado de cavidad, con colocación de drenajes. El análisis de líquido mostró aumento de triglicéridos y amilasa, gram y cultivos negativos; y la tomografía reveló una pancreatitis aguda (Baltazar C), todo ello confirmando el diagnóstico de AQ secundaria a pancreatitis. Paciente cursa con una evolución favorable con hidratación, analgésicos y dieta vía oral a tolerancia. En la literatura se han descrito muy pocos casos de PQA, y su asociación con pancreatitis aguda es bastante inusual. Pudiendo simular un cuadro abdominal agudo quirúrgico, cuyo tratamiento consiste en la exploración quirúrgica con drenaje peritoneal, pudiendo o no, requerir apoyo nutricional.

Chylous ascites (CA) is a rare condition, and it can present as a peritoneal reaction named acute chylous peritonitis (ACP). We report the case of a 26-year old male who developed acute abdomen. He underwent surgery and turbid milky fluid was found in his abdominal cavity. A prophylactic appendectomy was performed, as well as aspiration and lavage of the abdominal cavity. Drainage tubes were placed. Studies of the fluid revealed increased triglyceride and amylase contents. Gram-staining and cultures were negative. A computed tomography scan revealed acute pancreatitis (Balthazar C), so a diagnosis of chylous ascites secondary to pancreatitis was confirmed. The patient did well, he received hydration, analgesics, and oral diet according to tolerance. Very few cases of ACP have been reported in the literature, and its association with acute pancreatitis is very unusual. This condition may resemble surgical acute abdomen, and its management includes surgical exploration with peritoneal drainage. Nutritional support may also be needed.

Diagnostic value and influencing factors of chylous test of pleural effusion after thoracic surgery / 中国胸心血管外科临床杂志

@#Objective    To analyze the results and diagnostic value of postoperative chylous test of pleural effusion and to verify the clinicopathological factors affecting the results of chylous test. Methods    The clinical data of 265 consecutive patients undergoing selective surgery at the Department of Thoracic Surgery, Shangjin Nanfu Hospital between May and August 2020 were retrospectively analyzed, including 106 males and 159 females with an average age of 53.0±12.2 years. According to the results of the chylous test on the operation day and postoperative first and second days, the patients were divided into two subgroups, including a positive group and a negative group, and the clinical data of the two groups were compared. Sensitivity and specificity of the chylous test were calculated. The influencing factors for chylous test were analyzed by multiple logistic regression analysis. Results    The positive rate of chylous test was 91.7%, 95.8% and 87.9% on the operation day and postoperative first and second days, respectively. There was no statistical difference in age, sex, surgical type, surgical approach, surgical site, surgical time, degree of lymph node dissection, treatment of thoracic duct, 24 hours pleural fluid drainage or 24 hours protein and fat food intake between the positive group and the negative group (P>0.05). The diagnostic sensitivity and specificity of the chylous experiment were 100.0%and 4.0%, respectively. Multiple logistic regression analysis showed that the surgical site (left/right chest) might be an influencing factor for the results of the chylous test (P=0.043, OR=0.458, 95%CI 0.216-0.974). Conclusion    The positive rate of chylous test of pleural effusion after thoracic surgery is very high. The chylous test produces a high misdiagnosis rate of chylothorax. The surgical site (left/right chest) may be an influencing factor for chylous test. The positive result of chylous test is not recommended as the direct diagnostic basis for postoperative chylothorax and guidance of the subsequent treatment.

Thoracic duct lymphangioma and chylous ascites in a 24-year-old female

Lymphangiomas are rare and correspond to 0.7% to 4.0% of mediastinal tumors, and isolated mediastinal location occurs in 1% of cases. They are benign tumors that originate from a congenital malformation of the lymphatic vessels and are diagnosed more frequently in children less than 2 years of age. Chylous ascites is a clinical manifestation of thoracic duct lymphangioma and is composed of lymph accumulation caused by dilation of this lymphatic channel. It appears milky in the peritoneal cavity, containing triglyceride levels higher than 200 mg/dl. We report the case of a young patient with chylous ascites and lymphangioma of the thoracic duct, who was conservatively treated with octreotide and a low-fat diet with medium-chain triglycerides.

Manejo nutricional de ascitis quilosa: Serie de casos y revisión de la literatura

RESUMEN Las ascitis quilosa (AQ) es una entidad poco común producida por el acúmulo de linfa en la cavidad peritoneal. Su incidencia se describe en aumento progresivo, asociándose a una mortalidad de 40-70%. Se incluyeron 3 pacientes con diagnóstico de AQ evaluados en la visita de asistencia nutricional del Hospital Clínico de la Universidad Católica (UC) durante el año 2019. Caso 1: Paciente mujer de 47 años, consulta por dolor abdominal agudo realizándose apendicectomía. Estudio de líquido peritoneal con triglicéridos (TG) de 1.362 mg/dL. Inicia Nutrición Parenteral Total (NPTC) progresando luego a régimen oral. Estudio no revela lesiones de vasos linfáticos ni otras causas. Caso 2: Paciente varón de 68 años con cirrosis por alcohol, Child Pugh B. Ingresa por disnea y ascitis refractaria. Estudio de líquido ascítico y pleural, con TG de 439 mg/dL y 592 mg/dL respectivamente. Se manejó con toracocentesis y paracentesis evacuadoras, tratamiento con régimen hipograso y aporte de triglicéridos de cadena media (MCT) vía oral. Evolución tórpida requiriendo apoyo con NPTC, realizándose drenajes sucesivos, por lo que se instala TIPS. Caso 3: Paciente mujer de 63 años consulta por dolor hipogástrico con masa palpable subcostal derecha. Estudio confirma masa pancreática por lo que se realiza Whipple. Reingresa por náuseas y vómitos profusos, evidenciándose líquido ascítico con TG de 251 mg/dl. Se inicia NPTC, escasos débitos del drenaje iniciándose realimentación progresiva por vía oral. El análisis del líquido tras la paracentesis establece el diagnóstico de AQ pues la clínica es inespecífica. Las principales complicaciones están dadas por la pérdida de quilo: desnutrición, infecciones y sepsis. Las opciones de tratamiento incluyen: medidas dietéticas, fármacos e intervenciones percutáneas o quirúrgicas; siempre orientadas al alivio sintomático, con foco en tratar la causa. Si la tolerancia oral es óptima la primera medida es la supresión de la grasa y la suplementación con MCT para evitar déficit energético. Con el empleo de estas medidas se ha reportado el cierre espontáneo de fístulas y/o defectos de vasos linfáticos en un 75%-80%. Se concluye que no hay guías de recomendación y los estudios se basan en series de pocos casos clínicos. La ascitis quilosa es una entidad patológica rara, que representa una situación clínica crítica con consecuencias inmunológicas y nutricionales; y el tratamiento debe ser etiológico y el paso clave inicial es optimizar el estado nutricional del paciente.

ABSTRACT Chylous ascites (CA) is an uncommon entity caused by the accumulation of lymph in the peritoneal cavity, its incidence has been gradually increasing; being associated with a mortality of 40-70%. This work includes 3 patients with CA diagnosis evaluated by the Nutritional Assistance team in the Hospital Clínico of the Universidad Católica, Chile during 2019. Case 1: 47-year-old female, with acute abdominal pain that resulted in an appendectomy. Peritoneal fluid study showed triglycerides (TG) of 1362 mg/dL. Total Parenteral Nutrition (TPN) was initiated with successive changes to an oral regimen. The case was negative for lymphatic vessel injuries or other causes of AQ. Case 2: 68-year-old male with alcoholic cirrhosis, Child-Pugh B. The patient was admitted for dyspnea and refractory ascites. Ascites and pleural fluid study showed TG of 439 mg/dL and 592 mg/dL, respectively, whichwas managed with thoracentesis and evacuating paracentesis, treatment with a low-fat regimen, and oral medium chain triglycerides (MCT). Case 2 had a poor evolution requiring TPN and successive evacuations, with TIPS installed. Case 3: A 63-year-old female patient with hypogastric pain and palpable right subcostal mass. Study confirmed a pancreatic tumor and Whipple Surgery was performed. Case 3 was readmitted for nausea and vomiting, showing ascitic fluid with TG of 251 mg/dl. TPN was started, with decrease in drainage fluids and successful progressive oral refeeding. The analysis of the paracentesis fluid established the diagnosis of CA since the symptoms were nonspecific. The main complications were due to the loss of chyle: malnutrition, infections and sepsis. Treatment options included: dietary measures, drugs, and percutaneous or surgical interventions; always oriented to symptomatic relief, focused on etiologic treatment. If oral tolerance is optimal, the first measure should be fat suppression and supplementation with MCT to avoid energy deficit. With the use of these measures, spontaneous closure of fistulas and / or lymphatic vessel defects has been reported in 75% -80% of patients. There are no recommendation guidelines for CA and studies are based on series of a few clinical cases. CA is a rare disease, representing a critical clinical situation with immunological and nutritional consequences. Etiologic treatment must be prioritized with a focus on optimization of the nutritional status of the patient

Chylous ascites developing after open thoracoabdominal aortic aneurysm repair in a patient with marfan syndrome

Abstract Chylous ascites is the pathologic accumulation of chylous fluid in the peritoneal cavity, caused by lymphomas, metastatic malignancies, and abdominal surgeries, rarely due to surgical trauma of the cisterna chyli or its major branches. A 24-year-old man with history of Marfan syndrome presented to our hospital with abdominal distention, abdominal pain, fluid in the incision region, and weakness. He had underwent an elective open aneurysm repair surgery nine days before for thoracoabdominal aortic aneurysm. Computed tomography revealed massive fluid collection in the abdominal cavity, which was drained surgically. He was diagnosed with chylous ascites and was discharged after conservative treatment.

Tratamiento de quilotórax y quiloascitis refractaria en paciente cirrótico. Caso clínico

Chylous Ascites (CA) and chylothorax (CTx) are associated with obstruction, disruption or insufficiency of the lymphatic system. We report a 68-year-old male, with a history of alcoholic cirrhosis, who had recurrent events of CTx and CA. After a complete study, no other etiologies other than portal hypertension were found. Therapy with diuretics, nothing per mouth, parenteral feeding plus octreotide did not relieve symptoms. A transjugular intrahepatic portosystemic shunt (TIPS) was successfully placed and pleural effusion subsided. This case shows that CA and CTx can be caused by portal hypertension and they may subside employing a multimodal management strategy.

Fístula quilosa posoperatoria / Postoperative chylous fistula

Introducción: La fístula quilosa posoperatoria debida a lesión iatrogénica del conducto torácico es una complicación infrecuente y grave de la cirugía de cabeza y cuello. Objetivo: Describir las opciones de tratamiento de la fístula quilosa cervical posquirúrgica. Caso clínico: Se presenta un paciente de 18 años de edad con diagnóstico de linfangioma quístico de la región lateral izquierda del cuello, intervenido en el Servicio de Cirugía General del Hospital "Mnazi Mmoja", de Zanzíbar, Tanzania. Durante la evolución posoperatoria se constató una fístula quilosa de bajo débito la cual resolvió mediante tratamiento médico. El enfermo egresó curado a los 28 días después de la intervención quirúrgica. Conclusión: El tratamiento conservador es efectivo en la mayoría de las fístulas quilosas cervicales de bajo débito, mientras que en las de débito alto la cirugía ofrece una rápida resolución, aunque no existe consenso en torno al momento ideal para realizarla(AU)

Introduction: Postoperative chylous fistula due to iatrogenic thoracic duct injury is an infrequent and serious complication of head and neck surgery. Objective: To describe the treatment options of postoperative cervical chylous fistula. Clinical case: It was presented an 18-year-old patient with diagnosis of cystic lymphangioma of the left lateral region of the neck, which was removed in the General Surgery Service of the National Hospital Mnazi Mmoja of Zanzibar, Tanzania. During the postoperative evolution, a low-output chylous fistula was found and resolved by medical treatment. The patient withdrew cured at 28 days after the surgical intervention. Conclusion: Conservative treatment is effective in the majority of low-out put cervical chylous fistulas, while in high-debit, surgery offers a rapid resolution, although there is no consensus about the ideal time to perform it(AU)

Ascitis quilosa en el posoperatorio de hepatectomía derecha / Chylous ascites after right liver resection

La ascitis quilosa posoperatoria (AQP) se debe a acumulación de líquido rico en triglicéridos en la cavidad peritoneal tras una lesión en la cisterna del quilo o en sus afluentes. Es infrecuente verla después de una hepatectomía. Se presenta el caso de un varón de 44 años con adenocarcinoma a 16 cm del margen anal T3N1, con metástasis que ocupaba casi la totalidad del lóbulo hepático derecho. Luego de quimioterapia se realizó hepatectomía derecha, observándose al cuarto día postoperatorio líquido del drenaje endotorácico de aspecto lechoso, con triglicéridos 223 mg/dL y 77 mg/dL de triglicéridos séricos. Se inició dieta sin grasas, hiperproteica, con ácidos grasos de cadena media y octreótide (100 microgramos subcutáneos cada 8 horas), con resolución del cuadro. En conclusión, la complicación quilosa puede tratarse exitosamente con un abordaje menos agresivo, sin suprimir la ingesta oral, utilizando octreótide subcutáneo, dieta exenta de grasas, suplementada con proteínas y ácidos grasos de cadena media.

Postoperative chylous ascites is an intraperitoneal collection of lymphatic fluid enriched with long-chain triglycerides that results from injury of the cisterna chyli or its main tributaries. This complication is rare after liver resections. Here, we report on the case of a 44 year-old man with a T3N1 rectal adenocarcinoma 16 cm above the anal margin, with metastatic compromise of almost the entire right liver lobe. Following chemotherapy, he underwent right liver resection. On postoperative day four, the thoracic drain evidenced milky fluid containing triglyceride 223 mg/dL with serum triglycerides 77 mg/dL. A fat-free diet was indicated with fat-free protein supplements, medium chain triglycerides and octreotide (100 μg subcutaneously every 8 hours), with complete resolution. In conclusion, postoperative chylous complications may be treated successfully by a less aggressive approach, with oral diet, subcutaneous octreotide, fat-free diet supplemented with proteins and medium chain fatty acids.

Quiloperitoneo espontáneo en el embarazo / Spontaneous chyloperitoneum in pregnancy

Introducción. El quiloperitoneo consiste en la presencia de fluido linfático en la cavidad intraabdominal, complicación poco descrita en el embarazo y cuyas repercusiones no están bien establecidas.Reporte de caso. Se presenta el caso de una mujer gestante con embarazo de 36,5 semanas, sin comorbilidades, hospitalizada por presentar cifras tensionales elevadas asociadas a síntomas de encefalopatía hipertensiva y bradicardia fetal sostenida; se le practicó una cesárea urgente en la cual se evidenció corioperitoneo incidental. La tomografía computarizada abdominal de control no demostró alteraciones.Discusión. Se descartaron las principales causas del quiloperitoneo, las cuales son neoplasia maligna y trauma. Se consideró que se trataba de un quiloperitoneo espontáneo posiblemente relacionado con la congestión pélvica propia del embarazo, por vasodilatación secundaria al influjo hormonal, aumento de la presión intraabdominal y contribución del volumen ascítico por la preeclampsia, que genera ruptura traumática de los vasos linfáticos.Conclusión. La ascitis quilosa es una entidad poco frecuente que puede verse asociada con el embarazo. Es fundamental el criterio acertado del ginecoobstetra para determinar tempranamente la etiología

Introduction: Chyloperitoneum consists of the presence of a lymphatic fluid in the intra-abdominal cavity, a complication little described during pregnancy, and whose repercussions are not well established.Case report: A pregnant woman with a pregnancy of 36.5 weeks, without comorbidities, is hospitalized in the context of high blood pressure levels associated with symptoms of hypertensive encephalopathy and sustained fetal bradycardia, leading to an emergent cesarean section where incidental chorioperitoneum was evidenced. Posterior abdominal CT control showed no alterations.Discussion: The main associated etiologies (malignancy and trauma) were ruled out. It is considered a presentation of spontaneous chyloperitoneum that could be related to the pelvic congestion of pregnancy due to: vasodilatation secondary to hormonal influence, increased intra-abdominal pressure and contribution of ascites due to preeclampsia, generating traumatic rupture of lymphatic vessels.Conclusion: Chylous ascites is a rare entity that can be associated with pregnancy. It is essential that gynecologist and obstetrician correctly approach these patients to determine the etiology early

Think beyond ascites

In children with gross, persistent ascites wherein clinical scenario is not agreeable to common conditions, one needs to revise the diagnosis and rule out the surgical cause for abdominal distension mimicking ascites. We are reporting here, a case of two year old female child who presented with abdominal distension, clinically suggestive of ascites and subsequently diagnosed to have a large chylous mesenteric cyst which was determined on biochemical investigations, imaging and confirmed on surgical intervention. She was managed surgically with successful outcome.

Congenital chylous ascites: a case report

Due to the rarity of congenital chylous ascites and the lack of standards in diagnosis and therapy, this disease constitutes a medical challenge and individual therapy seems to be extremely important. A late preterm newborn with antenatally diagnosed ascites was born and chylous ascites was diagnosed after feeds were started. The baby was managed initially with nil per oral, parenteral nutrition and octreotide, followed by adding MCT formula feeds. Considering the rarity of neonatal chylous ascites and the non-uniformity in management plans and follow up, more case reports need to be published. Also, MCT formula, the main stay of management has to be discontinued as soon as possible with gradual introduction into breast feeds or normal newborn formula milk as long chain fatty acids are essential for optimal brain growth in newborns.