Lymphangiography with sclerotherapy:  a novel therapy for refractory chylous ascites.
BACKGROUND
We report the outcomes of a small series of patients with refractory chylous ascites following urologic surgery treated with lymphangiography +/- sclerotherapy.


METHODS
Retrospective review revealed three patients who underwent lymphangiography for prolonged lymphatic leak following urological surgery.  Contrast material is injected slowly into a lymphatic vessel on the dorsum of the foot and serial imaging is used to capture the location and degree of lymphatic leak in order to guide definitive treatment.  Demographic and clinical details were collected and are reported.


RESULTS
Three patients were identified from 2005-2008 (one following donor nephrectomy and two following retroperitoneal lymph node dissection).  All patients presented with abdominal distension within 30 days of surgery.  Traditional conservative measures failed in all patients. Lymphangiography localized all leaks (renal hilum, paraspinal, and retrocaval).  One patient elected for successful surgical repair after localization. The remaining two patients resolved immediately following lymphangiography; one of these patients underwent percutaneous doxycycline sclerosis.  With over 1 year of follow up there have been no recurrences or long term sequelae.


CONCLUSIONS
Lymphangiography is a valuable management option for the rare patient with chylous ascites refractory to conservative therapy.  Prompt resolution of prolonged chylous ascites following lymphangiography should encourage its use in such difficult cases.
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Jeffrey K
JK
Mullins
Phillip M
PM
Pierorazio
Elias S
ES
Hyams
Sally E
SE
Mitchell
Mohamad E
ME
Allaf
D000328:Adult; D002915:Chylous Ascites / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008220:Lymphography; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D015911:Sclerotherapy; D055815:Young Adult
D003287:Contrast Media