title: [Chylous ascites after laparoscopic nephroureterectomy].
abstract: A 65-year-old man underwent a laparoscopic nephroureterectomy with a radical retroperitoneal lymphadenectomy for transitional cell carcinoma in the pyelon of the left kidney associated with a paraaortal lymphadenopathy. Four weeks later the patient presented with weight loss, a distended abdomen and a swelling of the left hemiscrotum. With increasing complaints and the suspicion of a large lymphocele an exploratory laparoscopy with the possibility of a fenestration was performed. Intraoperatively the laparoscopy revealed a chylous ascites but failed to detect an injury to the lymph system and a localised leak. The ascites eventually resolved under a strict dietary regimen with a medium-chain triglyceride-based diet and repeated long-term drainage. We report this case to encourage a multimodal approach in this potentially fatal complication.
authors.affiliation: Klinik für Urologie und Kinderurologie, Helios Klinikum Wuppertal, Universität Witten-Herdecke, Wuppertal. friedrich.von-rundstedt@helioskliniken.de
authors.forename: F-C
authors.initials: FC
authors.lastname: von Rundstedt
authors.forename: L
authors.initials: L
authors.lastname: Kamper
authors.forename: A S
authors.initials: AS
authors.lastname: Brandt
authors.forename: D
authors.initials: D
authors.lastname: Lazica
authors.forename: S
authors.initials: S
authors.lastname: Roth
mesh_terms: D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D002915:Chylous Ascites / Q000175:diagnosis / Q000178:diet therapy / Q000209:etiology* / Q000601:surgery; D004322:Drainage; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D008197:Lymph Node Excision; D008297:Male; D009392:Nephrectomy; D011183:Postoperative Complications; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery