Chyloperitoneum Following Abdominal Aortic Surgery
Chyloperitoneum Following Abdominal Aortic Surgery
Chyloperitoneum is an uncommon but serious complication following abdominal aortic surgery. As there seems to be no uniformity concerning the treatment, we performed a literature search to evaluate the best treatment results. All Medline-cited articles on chyloperitoneum after abdominal aortic surgery were assessed and analyzed. Thirty-eight cases of chyloperitoneum following abdominal aortic surgery were found. Patients developed symptoms after a median of 16 days (range 2-120 days) and were asymptomatic after 68 days (mean, range 27-93 years). All patients underwent diagnostic paracentesis, which confirmed the diagnosis. In 26 cases (68%), paracentesis was part of the treatment. The use of diuretics (24%) as therapeutic value was abandoned. Total parenteral nutrition, used in 21 patients (55%), provides the possibility of an extended period of oral starvation that reduces the lymphatic flow from the leaking duct. Medium-chain triglyceride, used in 28 cases (76%), is generally accepted as reducing lymphatic flow. When all conservative measures fail, surgical exploration is indicated. Two surgical interventions were mentioned: placing a peritoneovenous shunt or transfixing the damaged lymph vessel; both were described with different outcomes. This review supports conservative treatment of chyloperitoneum following abdominal aortic surgery.
Chylous ascites is defined as the accumulation of free milk-like peritoneal fluid, rich in triglycerides, owing to the presence of thoracic or intestinal lymph in the abdominal cavity. Chyloperitoneum is an uncommon disease caused by various diseases or trauma (Table 1). The production of chylous ascites following abdominal aortic surgery is the result of a lymphatic fistula of traumatic origin between the cisterna chyli or adjacent major lymphatic trunks and the peritoneal cavity. Although lymphatic disruption is not an uncommon occurrence during surgical procedures in the retroperitoneal space, it rarely leads to clinically significant chyloperitoneum.
We reviewed the literature on symptomatic chyloperitoneum following abdominal aortic surgery with respect to incidence, pathophysiology, and therapy.
Abstract and Introduction
Abstract
Chyloperitoneum is an uncommon but serious complication following abdominal aortic surgery. As there seems to be no uniformity concerning the treatment, we performed a literature search to evaluate the best treatment results. All Medline-cited articles on chyloperitoneum after abdominal aortic surgery were assessed and analyzed. Thirty-eight cases of chyloperitoneum following abdominal aortic surgery were found. Patients developed symptoms after a median of 16 days (range 2-120 days) and were asymptomatic after 68 days (mean, range 27-93 years). All patients underwent diagnostic paracentesis, which confirmed the diagnosis. In 26 cases (68%), paracentesis was part of the treatment. The use of diuretics (24%) as therapeutic value was abandoned. Total parenteral nutrition, used in 21 patients (55%), provides the possibility of an extended period of oral starvation that reduces the lymphatic flow from the leaking duct. Medium-chain triglyceride, used in 28 cases (76%), is generally accepted as reducing lymphatic flow. When all conservative measures fail, surgical exploration is indicated. Two surgical interventions were mentioned: placing a peritoneovenous shunt or transfixing the damaged lymph vessel; both were described with different outcomes. This review supports conservative treatment of chyloperitoneum following abdominal aortic surgery.
Introduction
Chylous ascites is defined as the accumulation of free milk-like peritoneal fluid, rich in triglycerides, owing to the presence of thoracic or intestinal lymph in the abdominal cavity. Chyloperitoneum is an uncommon disease caused by various diseases or trauma (Table 1). The production of chylous ascites following abdominal aortic surgery is the result of a lymphatic fistula of traumatic origin between the cisterna chyli or adjacent major lymphatic trunks and the peritoneal cavity. Although lymphatic disruption is not an uncommon occurrence during surgical procedures in the retroperitoneal space, it rarely leads to clinically significant chyloperitoneum.
We reviewed the literature on symptomatic chyloperitoneum following abdominal aortic surgery with respect to incidence, pathophysiology, and therapy.
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