1500 Chyle Leakage Following Laparoscopic Cholecystectomy: A Problematic Post-Operative Complication

Abstract

Abstract Introduction Symptomatic choleliathiasis is a common surgical issue affecting 10% of the British population, of which laparoscopic cholecystectomy is the gold standard treatment. Asymptomatic chyle leakage post-laparoscopic cholecystectomy is an extremely rare complication. Case Report A 56-year-old man presents with right upper quadrant pain after recurrent episodes of acute cholecystitis. An MRCP showed small stones in the gallbladder and a stone in the distal common bile duct. The management was an urgent in-patient laparoscopic cholecystectomy. At operation, he was found to have significant gallbladder inflammation and a drain was left in-situ. On post-operative day 1, there was a triglyceride rich milky white drain fluid output, which was confirmed as chyle. Method The patient was asymptomatic and systematically well, so a conservative approach was taken. A strict low-fat diet resulted in resolution of the chyle leak, and the drain was removed on post-operative day 4. Follow-up at 8 weeks confirmed full recovery. Conclusions There are four recorded cases of such a phenomenon and is suggested it is caused by iatrogenic injury to the gallbladder fossa which may contain lymphatic vessels. The gold standard investigation is lymphoscintography, although drain fluid analysis and computed tomography imaging are more attainable investigations. Conservative management includes a fat-free diet, total parenteral nutrition and ocreotide whereas surgical management includes identifying the site of leakage and suturing it or applying fibrin glue. Lessons from this unexpected complication include treating the patient, cautiously monitoring the drain and considering surgical intervention if conservative management fails.