2005, Number 4
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Cir Cir 2005; 73 (4)
Conservative management of postoperative lymphatic fistula
García-Correa G, Aguilar-Sibilla CA, Murguía-Corral R, Espinosa-de los Monteros P
Language: Spanish
References: 16
Page: 307-310
PDF size: 96.90 Kb.
ABSTRACT
We describe the case of a diabetic patient who presented with a renal abscess that was surgically managed with neph-
rectomy. At the forth post-surgical day, the patient showed the presence of a “milky” looking fluid amounting to 1200 ml in 24 h through a Penrose drainage placed in the surgical resection site. After several studies, a diagnosis of lymphatic fistula was made. The first dietary management technique tried was not satisfactory, and total parenteral nutrition management was decided upon, obtaining a satisfactory outcome within a few days. We reviewed the literature where we found scant reported information on lymphatic fistulas following retroperitoneal surgery and we consider that because of more aggressive surgical techniques and more advanced technology for increased patient survival, doctors will witness a higher incidence of chylous fistulas or chylous ascites, which is why it is important to be aware of this complication.
REFERENCES
Browse NL, Wilson NM, Russo F, Al-Hassan H, Allen DR. Aetiology and treatment of chylous ascites. Br J Surg 1992;79(11):1145-1150.
2. Herz J, Shapiro SR, Honrad P, Palmer J. Chylous ascites following retroperitoneal lymphadenectomy. Report of 2 cases with guidelines for diagnosis and treatment. Cancer 1978;42:349-352.
3. Ablan CJ, Littooy FN, Freeark RJ. Postoperative chylous ascites: diagnosis and treatment. A series report and literature review. Arch Surg 1990;125:270-273.
4. Widjaja A, Gratz KF, Ockenga J, Wagner S, Mann MP. Octreotide for therapy of chylous ascites in yellow nail syndrome. Gastroenterology 1999;116(4):1017-1018.
5. Bozzeti F, Arullani A, Baticci F, Terno G, Ammatuna M, Capello G. Management of lymphatic fistulas by total parenteral nutrition. JPEN 1982;6(6):526-527.
6. Press OW, Press NO, Kaufman SD. Evaluation and management of chylous ascites. Ann Intern Med 1982;96:358-364.
7. Provenza JM, Bacon BR. Chylous ascites due to sarcoidosis. Am J Gastroenterol 1991;86(1):92-95.
8. Rutherford RB. Lymphatic complications of vascular surgery. In: Rutherford RB, editor. Vascular surgery. 5th ed. Philadelphia: W.B. Saunders; 2000. pp. 784-789.
9. Soetikno RM, Tantibhedhyangkul W, Binion D, Rouse R. Menetrier’s disease: report of a transient case associated with chylous ascites. Am J Gastroenterol 1997;92:1364-1367.
10. Carones S, Caporossi M, Di Paola S, Pagano G, Di Domenica M, Persico SL. Postoperative chylous ascites: its etiology and treatment. G Chir 1996;17:586-588.
11. Leibovitch I, Mor Y, Golomb J, Ramon J. The diagnosis and management of postoperative chylous ascites. J Urol 2002;167(1):449-457.
12. Ulibarri JI, Sanz Y, Fuentes C, Mancha A, Aramendia M, Sanchez S. Reduction of lymphorrhagia from ruptured thoracic duct by somatostatin. Lancet 1990;336:258-261.
13. Collard JM, Laterre PF, Boemer F, Reynaert M, Ponlot R. Conservative treatment of postsurgical lymphatic leaks with somatostatin-14. Chest 2000;117(3):902-905.
14. Laterre PF, Dugernier T, Reynaert MS. Chylous ascites: diagnosis, causes and treatment. Acta Gastroenterol Belg 2000;63(3):260-263.
15. Ferrandiere M, Hazouard E, Guicheteau V, et al. Chylous ascites following radical nephrectomy: efficiency of octreotide as treatment of a ruptured thoracic duct. Intensive Care Med 2000;26(4):484-485.
16. Salami OO, Allen DB, Organ CH Jr. Chylous ascites: a collective review. Surgery 2000;128(5):761-778.