Chylous ascites following retroperitoneal lymphadenectomy for testes cancer.
BACKGROUND
A 31-year-old man underwent a radical orchiectomy for a stage I mixed germ-cell tumor with angiolymphatic invasion. A subsequent laparoscopic retroperitoneal lymphadenectomy was complicated by a laceration to the aorta at the ostia of the more inferior of two right renal arteries. This was repaired following conversion to an open laparotomy. The patient presented 14 days later with genital swelling and increasing abdominal girth.


METHODS
Physical examination, abdominal and pelvic CT, laboratory albumin testing, lymphoscintogram and lymphangiogram.


METHODS
Chylous ascites with tracking of lymphatic fluid into the left groin through a defect in the internal inguinal ring.


RESULTS
Conservative management with salt restriction, a medium-chain fatty-acid diet and diuretics; exploratory laparoscopy, during which a small left inguinal hernia was repaired and chylous fluid was drained. Following further leakage, the patient was placed on total parenteral nutrition, followed by image-guided sclerotherapy with doxycycline.
Link
Richard E
RE
Division of Endourology and Minimally-Invasive Surgery, Scott Department of Urology at Baylor College of Medicine, Houston, TX 77030, USA. link@bcm.edu
Amin
Nivee
N
Kavoussi
Louis R
LR
D000328:Adult; D001012:Aorta, Abdominal / Q000293:injuries; D002915:Chylous Ascites / Q000209:etiology* / Q000628:therapy; D006552:Hernia, Inguinal / Q000150:complications; D006801:Humans; D007431:Intraoperative Complications; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000601:surgery*; D009919:Orchiectomy; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000601:surgery*