Rapid resolution of chylous ascites after liver transplantation using somatostatin analog and total parenteral nutrition.
Chylous ascites is the accumulation of chylomicronrich lymphatic fluid within the peritoneal cavity. It is a rare complication of retroperitoneal surgery, and may occur spontaneously in 0.5% of patients with cirrhosis. Its management is controversial, and despite a variety of treatment options with limited efficacy, the course is usually indolent. In this article, we report a case of rapid resolution of chylous ascites after liver transplantation following 10 days of treatment using somatostatin analog (Octreotide, 100 micrograms sc. t.i.d.) and total parenteral nutrition (TPN). A 55-year-old man underwent liver transplantation for hepatitis C cirrhosis, and developed an infected chylous fistula on the 10th day. Treatment by fasting, TPN, and somatostatin analog resulted in a rapid falloff in fistula output, with complete resolution of ascites within 2 days. This is the first report, to our knowledge, of somatostatin analog and TPN used in combination for rapid and successful closure of a chylous fistula.
Shapiro
A M
AM
Department of Surgery, University of Alberta, Edmonton, Canada.
Bain
V G
VG
Sigalet
D L
DL
Kneteman
N M
NM
D001201:Ascites / Q000188:drug therapy*; D002914:Chylomicrons; D005260:Female; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D010289:Parenteral Nutrition, Total
D002914:Chylomicrons; D006728:Hormones; D015282:Octreotide