Non-surgical management of a lymphatic fistula, after laparoscopic colorectal surgery, with total parenteral nutrition, octreotide, and somatostatin.
OBJECTIVE
We report the case of an external lymphatic fistula that appeared through an abdominal drainage after laparoscopic resection of the rectum and sigmoid colon for cancer, with lymphadenectomy. There was no chylous ascites because of controlled external drainage.


METHODS
The fistula was managed conservatively by interruption of oral feeding and administration of total parenteral nutrition and subcutaneous octreotide and management then shifted to intravenous somatostatin, with decreased lymph output through the fistula to 100 to 200 mL/d.


CONCLUSIONS
Somatostatin seemed to be more effective than subcutaneous octreotide. At postoperative day 18, refusal of treatment by the patient with oral resumption of clear liquids resulted in a transient increase in lymph output to 600 mL/d, and treatment was resumed. Subsequently, progressive withdrawal of the abdominal drainage was associated with complete healing of the fistula. The drain was removed at day 28, treatment was interrupted at day 30 after verifying by ultrasound the absence of chyloperitoneum, and the patient was discharged without further problems.
Giovannini
Ivo
I
Department of Surgical Sciences, Hepatobiliary Unit, Catholic University School of Medicine, Rome, Italy. ivo.giovannini@rm.unicatt.it
Giuliante
Felice
F
Chiarla
Carlo
C
Ardito
Francesco
F
Vellone
Maria
M
Nuzzo
Gennaro
G
D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D004322:Drainage; D005402:Fistula / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D008197:Lymph Node Excision / Q000009:adverse effects; D008206:Lymphatic Diseases / Q000209:etiology* / Q000628:therapy; D008297:Male; D015282:Octreotide / Q000627:therapeutic use*; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000628:therapy*; D012004:Rectal Neoplasms / Q000601:surgery; D013004:Somatostatin / Q000627:therapeutic use*; D016896:Treatment Outcome
D013004:Somatostatin; D015282:Octreotide