Chyloperitoneum following abdominal aortic surgery.
Chyloperitoneum is an uncommon but serious complication following abdominal aortic surgery. As there seems to be no uniformity concerning the treatment, we performed a literature search to evaluate the best treatment results. All Medline-cited articles on chyloperitoneum after abdominal aortic surgery were assessed and analyzed. Thirty-eight cases of chyloperitoneum following abdominal aortic surgery were found. Patients developed symptoms after a median of 16 days (range 2-120 days) and were asymptomatic after 68 days (mean, range 27-93 years). All patients underwent diagnostic paracentesis, which confirmed the diagnosis. In 26 cases (68%), paracentesis was part of the treatment. The use of diuretics (24%) as therapeutic value was abandoned. Total parenteral nutrition, used in 21 patients (55%), provides the possibility of an extended period of oral starvation that reduces the lymphatic flow from the leaking duct. Medium-chain triglyceride, used in 28 cases (76%), is generally accepted as reducing lymphatic flow. When all conservative measures fail, surgical exploration is indicated. Two surgical interventions were mentioned: placing a peritoneovenous shunt or transfixing the damaged lymph vessel; both were described with different outcomes. This review supports conservative treatment of chyloperitoneum following abdominal aortic surgery.
Olthof
Emilie
E
Department of Surgery, Spaarne Hospital, Hoofddorp, The Netherlands.
Blankensteijn
Jan D
JD
Akkersdijk
George J M
GJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D001019:Aortic Rupture / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery; D002915:Chylous Ascites / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use; D011183:Postoperative Complications / Q000175:diagnosis* / Q000628:therapy
D005765:Gastrointestinal Agents; D015282:Octreotide