title: A novel therapeutic strategy for chylous ascites after gynecological cancer surgery: a continuous low-pressure drainage system.
abstract: OBJECTIVE
  Postoperative chylous ascites is an unusual complication following retroperitoneal surgery. A search of the English literature showed only 44 cases of chylous ascites following gynecological cancer surgery. The treatment is primarily conservative, but surgical treatment is considered in resistant cases. We developed a novel non-surgical therapeutic strategy for postoperative chylous ascites.
  
  
  METHODS
  We report a case of severe chylous ascites following pelvic lymph node dissection for gynecological cancer.
  
  
  RESULTS
  Total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal washing, and systematic pelvic lymph node dissection were performed for a stage II G1 endometrioid adenocarcinoma (FIGO 2009). Forty-one days after surgery, the patient was readmitted due to massive ascites. Repeated paracentesis and a low-fat diet were only partially effective. Fifty-one days after surgery, we started paracentesis with a continuous low-pressure drainage system. Nine days later, there was no further fluid drainage. The patient was asymptomatic and without recurrent disease at follow-up 3 months later.
  
  
  CONCLUSIONS
  Pelvic lymph node dissection may cause postoperative chylous ascites. Paracentesis with a continuous low-pressure drainage system can be an effective conservative treatment for postoperative chylous ascites.
authors.affiliation: Department of Obstetrics and Gynecology, National Hospital Organization Sendai Medical Center, 2-8-8 Miyagino, Miyagino-ku, Sendai, 983-8520, Japan. a2mb1050-thk@umin.ac.jp
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shibuya
authors.forename: Koh
authors.initials: K
authors.lastname: Asano
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hayasaka
authors.forename: Takashi
authors.initials: T
authors.lastname: Shima
authors.forename: Kozo
authors.initials: K
authors.lastname: Akagi
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Ozawa
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Wada
mesh_terms: D018269:Carcinoma, Endometrioid / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D002915:Chylous Ascites / Q000209:etiology* / Q000628:therapy*; D004322:Drainage / Q000379:methods; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008875:Middle Aged; D019152:Paracentesis; D010388:Pelvis; D011183:Postoperative Complications / Q000628:therapy*