Chylous ascytis causing abdominal distension after laparoscopic radical nephrectomy.

OBJECTIVE: To report a case of large chylous ascytis as a late complication of a laparoscopic nephrectomy for renal tumor. METHODS: A 62 year old patient was admitted with general deterioration and abdominal distension due to chylous ascites. Abdominal ultrasound and CT led to the diagnosis. Paracentesis confirmed the presence of a large peritoneal chylous fluid effusion. RESULTS: The patient was treated by punction and placement of a percutaneous drainage. A large amount of lymphatic fluid was obtained after punction with a progressive decrease. Medical treatment included low sodium and low fat diet, together with medium chain fast absorbing triglycerides, protein supplements, diuretics and somatostatin analogues (octeotride). The patient's progress was satisfactory after several days of treatment. CONCLUSIONS: Chylous ascites is a rare complication of laparoscopic nephrectomy, but it has a favorable course if managed conservatively. Meticulous clipping of the retroperitoneal lymph vessels is recommended to prevent the formation of chylous ascites, especially when discharging the renal vascular pedicle during nephrectomy or extensive lymphadenectomy.

Ascitis quilosa tras neferctomia radical laparascopica que provoca distensión abdominal / Chylous ascytis causing abdominal distension after laparoscopic radical nepherectomy

OBJETIVO: Comunicar un caso de ascitis quilosa masiva como complicación tardía tras la realización de una nefrectomía laparoscópica por tumor renal. MÉTODOS: Presentamos el caso de un varón de 62 años que ingresó por distensión abdominal importante, y malestar general motivado por ascitis quilosa. El diagnóstico realizado mediante ecografía y TAC abdominal con paracentesis confirmó la presencia de abundante acumulo intraperitoneal del liquido lechoso. RESULTADOS: El paciente fue tratado con punción y drenaje peritoneal percutáneo que recogió abundante cantidad de linfa en las primeras horas y disminución del débito de forma progresiva. El tratamiento médico consistió en dieta hiposódica y baja en grasa, triglicéridos de cadena media de absorción rápida, suplementos de proteínas, diuréticos, y análogos de la somatostatina (octeotride). El enfermo evolucionó de forma satisfactoria al cabo de unos días. CONCLUSIONES: La ascitis quilosa es una complicación rara tras la nefrectomía laparoscópica y suele evolucionar bien con tratamiento conservador. Para prevenir su aparición se recomienda un clipaje meticuloso del tejido linfático retroperitoneal sobre todo al realizar la disección del pedículo vascular renal en el caso de nefrectomías o linfadenectomías extensas

OBJECTIVE: To report a case of large chylous ascytis as a late complication of a laparoscopic nephrectomy for renal tumor. METHODS: A 62 year old patient was admitted with general deterioration and abdominal distension due to chylous ascites. Abdominal ultrasound and CT led to the diagnosis. Paracentesis confirmed the presence of a large peritoneal chylous fluid effusion. RESULTS: The patient was treated by punction and placement of a percutaneous drainage. A large amount of lymphatic fluid was obtained after punction with a progressive decrease. Medical treatment included low sodium and low fat diet, together with medium chain fast absorbing triglycerides, protein supplements, diuretics and somatostatin analogues (octeotride). The patient’s progress was satisfactory after several days of treatment. CONCLUSIONS: Chylous ascites is a rare complication of laparoscopic nephrectomy, but it has a favorable course if managed conservatively. Meticulous clipping of the retroperitoneal lymph vessels is recommended to prevent the formation of chylous ascites, especially when discharging the renal vascular pedicle during nephrectomy or extensive lymphadenectomy

Litiasis piélica gigante en paciente monorreno funcional: Pielolitotomía / No disponible

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