title: Successful radiation treatment of chylous ascites following pancreaticoduodenectomy.
abstract: Chylous ascites is a rare complication following pancreaticoduodenectomy. We report on a case of chylous ascites following pancreaticoduodenectomy in a 76-year-old patient diagnosed with pancreatic cancer. There are various known conservative management strategies, including dietary measures or total parenteral nutrition. Unfortunately, conservative treatment-with total parenteral nutrition and fasting over a period of 4 weeks-was not successful in the present case. The daily output volume of chylous ascites was up to 2500 ml/day. Based on clinical experiences with successfully treated lymphocutaneous fistulas, low-dose radiotherapy was initiated. External beam radiotherapy comprising a total dose of 8.0 Gy to the paraaortic lymph node region was administered in daily single fractions of 1.0 Gy (five fractions/week). Throughout the course of external beam radiotherapy, the secretion of abdominal ascites rapidly decreased, resulting in complete resolution after 2 weeks. There was no clinical evidence of chylous ascites on follow-up. As a result of this experience, we believe that external beam radiotherapy should be considered as an alternative therapy in refractory cases of chylous ascites.
authors.affiliation: Department of Radiation Oncology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany, stefanie.corradini@med.uni-muenchen.de.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Corradini
authors.forename: Sylke
authors.initials: S
authors.lastname: Liebig
authors.forename: Olivier M
authors.initials: OM
authors.lastname: Niemoeller
authors.forename: Felix
authors.initials: F
authors.lastname: Zwicker
authors.forename: Wolfram
authors.initials: W
authors.lastname: Lamadé
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002915:Chylous Ascites / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000528:radiation effects; D008297:Male; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D016896:Treatment Outcome