Chyloperitoneum as the Initial Manifestation of Gastrointestinal Neoplasia

Ivan David Lozada-Martínez,Paola Zuluaga-Ramírez,Ana María Ríos-Giraldo,Victor Hugo Mendoza-Brochero,Daniela Torres-Llinás,María Bolaño-Romero

doi:10.3390/surgeries2020017

Ivan David Lozada-Martínez, Paola Zuluaga-Ramírez + Show 4 more

Open Access

https://doi.org/10.3390/surgeries2020017

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Abstract

Chyloperitoneum is defined as the presence of lymph within the peritoneal cavity, resulting from obstruction or injury of lymph ducts, mostly at the level of the gastrointestinal tract. This can occur in the context of congenital diseases, traumas, infections, neoplasms, hepatic disease, heart disease, and postoperative complications. The most common symptoms described are abdominal distention and mild pain in a course of weeks to months, with dyspnea, peritonitis, and in a few cases weight gain is observed due to the high intra-abdominal pressure. We present a case of a 56-year-old male with no significant personal history, who has a clinical picture of approximately three months of evolution, consisting in sensation of an abdominal mass predominantly in the left hemiabdomen, associated with progressive abdominal distension, changes in intestinal habit, lower limb edema, dyspepsia, occasional postprandial emesis, and unintentional weight loss of 20 kg. In non-traumatic conditions, the most frequent cause of chylous ascites is a malignancy disease followed by cirrhosis and mycobacterial infections. Taking into consideration that adenocarcinoma is the most frequently reported histologic subtype of jejunum neoplasm, and that not all cases of lymphoma debut with chylous ascites, it can be concluded that the proportion of patients that present with this condition is exceptionally low. Chyloperitoneum is an infrequent finding, having the higher detection rate in lymphatic alterations and malignancies of gastrointestinal location, in which some of the most commonly neoplasms associated with this complication are lymphoma, neuroendocrine tumors, sarcomas, and leukemia.

Highlights

The lymph is a fluid that originates in the interstitial space composed of cells, proteins, chylomicrons, and occasionally bacteria
If the above occurs in the context of a peritoneal effusion, it is referred to as chyloperitoneum or chylous ascites [2]
Chyloperitoneum fluid is rich in biologically unavailable nutrients and immunoglobulins after accumulation in the peritoneum, which can lead to dehydration, malnutrition, electrolyte-hydric alteration, and immunosuppression [4]

Summary

Introduction

The lymph is a fluid that originates in the interstitial space composed of cells, proteins, chylomicrons, and occasionally bacteria. Chyloperitoneum is considered an uncommon yet severe complication during abdominal surgery [6] It occurs most often during postoperative retroperitoneal lymph node dissection, distal splenic shunt, abdominal aortic aneurysm repair, or liver transplant [5,7], while its presentation as a complication of colorectal cancer surgery is exceptional [8]. A 56-year-old Black man, working as an accountant, from an urban area, with a clinical history of approximately three months of evolution His symptoms consisted of the sensation of an abdominal mass, predominantly in the left hemiabdomen, associated with progressive abdominal distension, changes in bowel habits, lower limb edema, dyspepsia, occasional postprandial emesis, and unintended 20 kg weight loss. The patient evolved satisfactorily, tolerating diet on his first postoperative day, with adequate control of abdominal pain, improvement in intestinal transit, and marked decrease in ascites, without complications inherent to the surgical procedure.

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