title: Unconventional management of chyloascites after laparoscopic Nissen fundoplication.
abstract: OBJECTIVE
  Chyloascites is a rare complication that can result from abdominal trauma, neoplasm, inflammatory conditions, or various abdominal surgeries. Few cases have been described secondary to iatrogenic injury from laparoscopic Nissen fundoplication. We describe a case in which this surgery resulted in chyloascites that was successfully treated by lymphatic glue embolization.
  
  
  METHODS
  A 37-year-old male presented with signs and symptoms consistent with chronic reflux disease. He underwent an uneventful laparoscopic Nissen fundoplication. Two weeks postoperatively, he was admitted for dehydration. During his admission, he began to develop a persistent cough, shortness of breath, and abdominal distention. Imaging and fluid analysis from thoracocentesis and paracentesis were consistent with chyle leakage. Despite nonoperative measures, the patient's presentation persisted.
  
  
  RESULTS
  Thoracic duct ligation was performed without success. Bipedal lymphangiography identified an extensive leak revealing a severely lacerated thoracic duct spilling contrast freely into the abdomen and no contrast entering the thoracic duct in the chest. The site of injury was successfully sealed off with percutaneous glue embolization through lymph channels.
  
  
  CONCLUSIONS
  Chyloascites is a rare complication of laparoscopic Nissen fundoplication. When not successful with conservative measures, lymphatic glue embolization can provide effective treatment.
authors.affiliation: Department of Surgery, General Surgery Service, Walter Reed Army Medical Center, Washington, DC 20307, USA. Paul.F.Hwang@us.army.mil
authors.forename: Paul F
authors.initials: PF
authors.lastname: Hwang
authors.forename: Karen A
authors.initials: KA
authors.lastname: Ospina
authors.forename: Earl H
authors.initials: EH
authors.lastname: Lee
authors.forename: Scott R
authors.initials: SR
authors.lastname: Rehring
mesh_terms: D000328:Adult; D002915:Chylous Ascites / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods; D004659:Enbucrilate / Q000627:therapeutic use*; D018662:Fundoplication / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D019152:Paracentesis; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology; D013897:Thoracic Duct / Q000293:injuries*; D014057:Tomography, X-Ray Computed
chemical_list: D004659:Enbucrilate