Abstract
BackgroundIatrogenic injury of the thoracic duct with clinical significant chyloperitoneum is a rare complication of abdominal surgery. Chyloperitoneum following laparoscopic Nissen fundoplication has been described in a few cases only. Most interventionists use the antegrade transperitoneal approach for thoracic duct embolization.Case presentationA 61-year-old woman had been operated with laparoscopic Nissen fundoplication and hiatoplasty. A few weeks later she presented with high-output chyloperitoneum due to large leakage of the proximal thoracic duct. Conservative treatment and conventional transnodal lymphangiography did not result in a significant improvement. Thoracic duct embolization via retrograde transvenous access was challenging but both technically and clinically successful.ConclusionTo the best of our knowledge, this is the first case-report about thoracic duct embolization with retrograde transvenous access in the rare situation of chylous ascites following laparoscopic fundoplication. Thoracic duct embolization with the seldom used retrograde transvenous access may be the more physiologic and safer route in doing this and might be used as treatment of first choice.
Highlights
ConclusionTo the best of our knowledge, this is the first case-report about thoracic duct embolization with retrograde transvenous access in the rare situation of chylous ascites following laparoscopic fundoplication
Iatrogenic injury of the thoracic duct with clinical significant chyloperitoneum is a rare complication of abdominal surgery
To the best of our knowledge, this is the first case-report about thoracic duct embolization with retrograde transvenous access in the rare situation of chylous ascites following laparoscopic fundoplication
Summary
This case report illustrates that retrograde transvenous TDE is feasible even in the setting of TDinjury following surgery with high-output chyloperitoneum, where the TD is exceedingly small because of sparse filling due to a large lymph leakage. As about one third of antegrade TDE-attempts turn out to be technically unfeasible, the less invasive retrograde approach for TDE appears to be a valuable option for TDE and should be taken into account more frequently
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