Prediction of prolonged resolution of chylous ascites after radical D3 resection for colorectal cancer: A population-based experience from a high-volume center.

AIM: This study was aimed to analyze the incidence, risk factors, and management of chylous ascites (CA) after radical D3 resection for colorectal cancer, and to construct a predicting nomogram for prolonged resolution of CA. METHOD: Consecutive colorectal cancer patients who underwent radical D3 resection were included. Logistic analysis was used to identify risk factors of postoperative CA, as well as prolonged CA resolution. A predictive nomogram for prolonged resolution of CA was developed and validated internally. RESULTS: Among 7167 patients included, 277 (3.8%) patients developed CA. Logistic regression analysis demonstrated that laparoscopic operation (OR 1.507; P = 0.017) and tumors fed by the superior mesenteric artery (SMA, OR 2.456; P < 0.001) were independent risk factors of postoperative CA following radical D3 surgery for colorectal cancer. Open operation (OR 0.422; P = 0.027), drainage output on the first day of treatment (OR 1.004; P = 0.016), time to oral intake (OR 1.273; P = 0.042), and time to onset (OR 1.231; P = 0.024) were independently associated with prolonged resolution of postoperative CA (≥7 days). A predictive nomogram for prolonged CA resolution was developed with a C-index of 0.725. CONCLUSION: The incidence of CA after radical D3 surgery of colorectal cancer was 3.8%. Open operation, drainage output on the first day of treatment, time to oral intake, and time to onset were independently associated with prolonged resolution of postoperative CA. A nomogram may assist in tailored treatment decision-making and counseling patient with treatment strategies.

[Spontaneous diffuse chylous peritonitis during pregnancy]. / Spontannyi khileznyi peritonit vo vremia beremennosti.

Spontaneous chylous peritonitis during pregnancy is a rare disease. Only a few publications are currently devoted to this problem. The authors reported successful treatment of a patient with spontaneous chylous peritonitis in the first trimester of pregnancy. Moreover, etiology, epidemiology, pathophysiology, diagnosis and treatment of patients with spontaneous chylous peritonitis and chiloperitoneum are analyzed. The authors consider laparoscopy as a safe and efficient method of treatment of patients with spontaneous chylous peritonitis including pregnant women.

When the color of peritoneal dialysis effluent can be used as a diagnostic tool.

Peritoneal dialysis (PD) effluent is normally transparent. A change in its appearance may be the first indication of an intra- or extraperitoneal abnormality which may or may not be related to the peritoneal dialysis technique itself. What diagnosis should be considered when PD effluent turns on red, orange, cloudy, milky white, green, yellow, purple or black in color? After review of the literature, we propose a differential diagnosis, as well as some management recommendations, for specific abnormal color presentations of the PD effluent.

Percutaneous Treatment of Chylous Ascites.

Chylous ascites occurs as a result of lymphatic leakage, which contains high concentration of triglycerides. The leakage is caused by various benign or malignant etiologies ranging from congenital lymphatic abnormality to trauma. Lymphangiography has been shown to be effective in the diagnosis of lymphatic leakage and has also been reported to have therapeutic outcome. The development of intranodal technique for lymphangiography has recently made the procedure more widespread. As an adjunctive procedure, percutaneous embolization may be performed which involves use of embolic agents such as N-butyl cyanoacrylate and coil to occlude the leak. Embolization in the lymphatic system was first made popular by the introduction of thoracic duct embolization by Cope et al and has recently led to the development of various techniques for percutaneous embolization. This article reviews the options and techniques for percutaneous treatment of lymphatic leaks in patients presenting with chylous ascites.

Chylous ascites after pedicled transverse rectus abdominis myocutaneous flap harvest.

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.

Manejo de las fístulas de quilo, una rara complicación tras cirugía urológica / Management of chylous fistulas, a rare complication after urologic surgery

OBJETIVO: Analizar los diferentes tratamientos para la fístula de quilo postoperatorias. MÉTODOS: Realizamos una revisión bibliográfica de los principales tratamientos para la fístula de quilo postoperatorias, aportando nuestra experiencia inicial de dos casos de pacientes con quilorrea postquirúrgica, con tratamiento conservador. RESULTADO: Existe muy poca experiencia del tratamiento de la ascitis quilosa, puede utilizarse, según la literatura revisada, el octreótide (análogo de la somatostatina), aportamos fueron tratados exitosamente con octreótide subcutáneo, disminuyendo el débito del drenaje en 3 días aproximadamente. CONCLUSIONES: El uso del octreótide aparece como un tratamiento efectivo en el manejo de las fístulas quilosas, y sugerido por algunos autores como tratamiento de primera línea en el manejo de estas, disminuyendo así las complicaciones que la pérdida de quilo puede conllevar

OBJECTIVE: To analyze the different treatments for postoperative chylous fistulae. METHODS: A literature review of the main treatments for postoperative chylous fistula, providing our initial experience of two cases of patients with postsurgical chylorrea, with conservative treatment. RESULTS: There is very limited experience in the treatment of chylous ascites. According to the literature reviewed, Octreotide (somatostatin analogue) can be used, to decrease fistula output. Both our cases cases were treated successfully with subcutaneous octreotide, with drain debit decrease in about 3 days. CONCLUSIONS: The use of octreotide appears to be an effective treatment in the management of chylous fistulae, and it is suggested by some authors as first-line treatment in the management of these, thus decreasing the complications that can appear due to chyle loss

Transjugular intrahepatic portosystemic shunt for treatment of cirrhosis-related chylothorax and chylous ascites: single-institution retrospective experience.

PURPOSE: To investigate the efficacy and safety of the use of transjugular intrahepatic portosystemic shunt (TIPS) creation to treat cirrhosis-related chylous collections (chylothorax and chylous ascites). METHODS: We retrospectively reviewed data from four patients treated for refractory cirrhosis-related chylous collections with TIPS at our institution over an 8 year period. RESULTS: One patient had chylothorax, and three patients had concomitant chylothorax and chylous ascites. There were no major complications, and the only procedure-related complications occurred in two patients who had mild, treatable hepatic encephalopathy. All patients had improvement as defined by decreased need for thoracentesis or paracentesis, with postprocedure follow-up ranging from 19 to 491 days. CONCLUSION: TIPS is a safe procedure that is effective in the treatment of cirrhosis-related chylous collections.

Spectrum of pericardial disease: part II.

Pericardial disease is a common disorder seen in varying clinical settings, and may be the first manifestation of an underlying systemic disease. In part I, we focused on the current knowledge and management of the more common pericardial diseases: acute pericarditis, pericardial effusion, cardiac tamponade, chronic pericarditis and relapsing pericarditis. In part II, we will focus on the knowledge and management of pericardial involvement in chylous pericardial effusion cholesterol pericarditis, radiation pericarditis, pericardial involvement in systemic inflammatory diseases, autoreactive pericarditis, pericarditis in renal failure, pericardial constriction and effusive constrictive pericarditis.

Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review.

Cisterna chyli is prone to injury in any retroperitoneal surgery. However, retroperitoneal chylous leakage is a rare complication after anterior spinal surgery. To the best of our knowledge, only ten cases have been reported in the English literature. We present a case of a 49-year-old man who had lumbar metastasis and associated radiculopathy. He had transient retroperitoneal chylous leakage after anterior tumor decompression, interbody bony fusion, and instrumental fixation from L2 to L4. The leakage stopped spontaneously after we temporarily clamped the drain tube. Intraperitoneal ascites accumulation developed thereafter due to nutritional loss and impaired hepatic reserves. We gathered ten reported cases of chylous leak after anterior thoracolumbar or lumbar spinal surgery, and categorized all these cases into two groups, depending on the integrity of diaphragm. Six patients received anterior spinal surgery without diaphragm splitting. Postoperative chylous leak stopped after conservative treatment. Another five cases received diaphragm splitting in the interim of anterior spinal surgery. Chylous leakage stopped spontaneously in four patients. The remaining one had a chylothorax secondary to postop chyloretroperitoneum. It was resolved only after surgical intervention. In view of these cases, all the chylous leakage could be spontaneously closed without complications, except for one who had a secondary chylothorax and required thoracic duct ligation and chemopleurodesis. We conclude that intraoperative diaphragm splitting or incision does not increase the risk of secondary chylothorax if it was closed tightly at the end of the surgery and the chest tube drainage properly done.

Octreotide in the outpatient therapy of cirrhotic chylous ascites: a case report.

Chylous ascites is a rare complication of liver cirrhosis associated with a poor short-term prognosis. We report the case of an 80-year-old male cirrhotic patient with refractory chylous ascites associated with portal hypertension. He was treated with total parenteral nutrition but chylous ascites relapsed at suspension. Patient was put on long-term subcutaneous octreotide (100 microg t.i.d.) as an outpatient. The treatment was well tolerated and led to clinical improvement, markedly reducing the need of total paracentesis and the amount of ascites. Octreotide was stopped after 6 months, and massive ascites did not relapse. After 1 year the patient was alive, with no need of paracentesis. Octreotide therapy should be considered in patients with cirrhosis and chylous ascites to simplify the outpatient management of the disease.

Postoperative chylous ascites in a neonate treated successfully with octreotide: bile sludge and cholestasis.

We report a case of postoperative chylous ascites after surgical repair of congenital diaphragmatic hernia (CDH) in a full-term neonate. Treatment with subcutaneously administered octreotide resulted in rapid resolution of chylous effusion. Octreotide treatment had transient side effects, with bile sludge and cholestasis.