Four Cases of Chylous Ascites following Robotic Gynecologic Oncological Surgery

Ahmet Göçmen,Muhittin Eftal Avcı,Mustafa Gazi Uçar,Fatih Şanlıkan

doi:10.1155/2014/953965

Abstract

Chylous ascites is an uncommon form of ascites characterized by milky-appearing fluid caused by blocked or disrupted lymph flow through chyle-transporting vessels. The most common causes of chylous ascites are therapeutic interventions and trauma. In this report, we present four cases of chylous ascites following robot-assisted surgery for endometrial staging and the treatment strategies that we used. After retroperitoneal lymph node dissection, leaving a drain is very useful in diagnosing chylous ascites and observing its resolution; furthermore, the use of octreotide in conjunction with TPN appears to be an efficient treatment modality for chylous ascites and should be considered before any invasive intervention.

Highlights

Chylous ascites is an uncommon form of ascites characterized by milky-appearing fluid caused by blocked or disrupted lymph flow through chyle-transporting vessels
Surgical lymph node dissection is the most common iatrogenic cause, and a small amount of lymphatic leakage may occur after every lymphadenectomy, but such leaks generally seal spontaneously without development of symptomatic ascites, whereas damage to a major lymphatic channel during surgery may cause the continuous collection of lymphatic fluid in the retroperitoneal and abdominal cavities [3]
Three of our four cases occurred in the early period and one case occurred in the late period

Summary

Introduction

Chylous ascites is an uncommon form of ascites characterized by milky-appearing fluid caused by blocked or disrupted lymph flow through chyle-transporting vessels. The most common causes of chylous ascites are therapeutic interventions and trauma. The increase in the incidence of chylous ascites is attributed to the longer survival of patients with cancer and more aggressive abdominal, retroperitoneal, and cardiothoracic interventions, despite the lack of recent large studies [1]. The recommended treatment options for chylous ascites are therapeutic paracentesis, dietary control with a high-protein, low-fat, medium-chain triglyceride- (MCT-) based diet, total parenteral nutrition (TPN), somatostatin, and surgical intervention [2]. We present four cases of chylous ascites following robot-assisted surgery for gynecologic malignancies and their management

Case Presentations

Discussion