Chylous ascites complicating elective abdominal aortic aneurysm repair: case report and review of treatment options.

Hashem M Barakat, Yousef Shahin, Peter McCollum

Journal: Vascular and endovascular surgery 2013;46(8):682-5

PMID: 22903333

Abstract

INTRODUCTION

Chylous ascitis is a rare complication of abdominal aortic aneurysm (AAA) surgery with only 38 cases reported since the early 70s. Due to their anatomical relation with the abdominal aorta, cisterna chyli injury is more common following open AAA repairs when compared to other surgeries; 81% of all postsurgical chylous ascites reported.

CASE PRESENTATION

We present a case of severe chylous ascitis following elective AAA repair in a 76-year-old caucasian male who gradually developed abdominal distension following discharge. A conservative approach was followed by a peritoneovenous shunt insertion, but this had no clinical benefit. The site of chyle leak was identified and ligated at relaparatomy to eventually resolve his ascitis.

CONCLUSION

Many reports in literature demonstrate successful conservative measures and highlight the importance of nutritional status in the course of persistent postoperative chylous ascitis. In our experience, complete resolution only came after relaparatomy and repair of leaking lymphatics.

Address: Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, Hull, United Kingdom. [email protected]

DOI: 10.1177/1538574412457083

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MeSH Terms: Aged, Aortic Aneurysm, Abdominal, Blood Vessel Prosthesis Implantation, Chylous Ascites, Combined Modality Therapy, Drainage, Elective Surgical Procedures, Endovascular Procedures, Gastrointestinal Agents, Humans, Ligation, Male, Octreotide, Parenteral Nutrition, Total, Peritoneovenous Shunt, Reoperation, Severity of Illness Index, Tomography, X-Ray Computed, Treatment Outcome