Chylous ascites complicating elective abdominal aortic aneurysm repair: case report and review of treatment options.
BACKGROUND
Chylous ascitis is a rare complication of abdominal aortic aneurysm (AAA) surgery with only 38 cases reported since the early 70s. Due to their anatomical relation with the abdominal aorta, cisterna chyli injury is more common following open AAA repairs when compared to other surgeries; 81% of all postsurgical chylous ascites reported.


METHODS
We present a case of severe chylous ascitis following elective AAA repair in a 76-year-old caucasian male who gradually developed abdominal distension following discharge. A conservative approach was followed by a peritoneovenous shunt insertion, but this had no clinical benefit. The site of chyle leak was identified and ligated at relaparatomy to eventually resolve his ascitis.


CONCLUSIONS
Many reports in literature demonstrate successful conservative measures and highlight the importance of nutritional status in the course of persistent postoperative chylous ascitis. In our experience, complete resolution only came after relaparatomy and repair of leaking lymphatics.
Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, Hull, United Kingdom. hashem.barakat@gmail.com
Hashem M
HM
Barakat
Yousef
Y
Shahin
Peter
P
McCollum
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002915:Chylous Ascites / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D003131:Combined Modality Therapy; D004322:Drainage; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects*; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D008026:Ligation; D008297:Male; D015282:Octreotide / Q000627:therapeutic use; D010289:Parenteral Nutrition, Total; D010536:Peritoneovenous Shunt; D012086:Reoperation; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D015282:Octreotide