Chylous ascites is a rare,
but severe complication after resection of retroperitoneal and iliacal lymph nodes (incidence of 0.9% after laparoscopic lymph node dissection in gynecological malignancies according to a study by Zhao et al.
Due to the loss of lipids it can lead to a catabolic situation.
Imaging of lymph vessels and lymph fistulas is challenging.
Treatment options are surgery,
interventional procedures and conservative treatment.
The goal of this publication is to review and discuss the different treatment options of chylous ascites due...
Due to the small size of lymph vessels the detection of a lymph fistula is challenging.
Some fistulas can be detected by lymphography and lymph scintigraphy.
The intraoperative injection of methylene blue into lymph vessels can show the leak of a lymph vessel.
There is no consensus on the management of chyle leaks (6) and the low number of patients results in the lack of prospective therapy studies.
Non invasive treatment with bowel rest,
parenteral nutrition and pharmacological therapies etc.
will not stop a lymph...
Findings and procedure details
In a patient (age 63 years,
female) a radical hysterectomy and lymphonodectomy was performed due to uterine cervix carcinoma.
After surgery high amounts of chylous ascites and transvaginal loss of ascites (2000 ml/d) occurred.
Due to the catabolic situation as a result of the loss of lipids the intended chemoradiation could not be started and the postoperative recovery was delayed.
The initial conservative treatment was not effective.
The postoperative CT scan (Fig.
6) showed a small fluid collection in the retroperitoneal space between the inferior...
Interventional embolisation of a retroperitoneal postoperative lymph fistula detected by direct CT-lymphography provides an effective alternative to conservative treatment and open surgery.
The combination of Ethoxysclerol and Histoacrylwas more efficient than the primary attempt with a blood patch.
Andreas Witteler (1)
Nurgül Acar (2)
Jens Altenbernd (1)
Thomas Schwenzer (2)
(1) Klinik für Radiologie und Neuroradiologie,
Zhou Q.Chylous ascites after laparoscopic lymph node dissection in gynecologicmalignancies.J Minim Invasive Gynecol.
Epub 2013 Jul 27.
Jacobi V.Direct lymphangiography as treatment option of lymphatic leakage: Indications,
outcomes and role in patient's management.Eur J Radiol.
2014 Oct 2;83(12):2167-2171.
[Epub ahead of print]
Tovar JA.Chylothorax and chylous ascites: Management and pitfalls.Semin Pediatr Surg....