Successful laparoscopic ligation for massive chylous ascites after rectal cancer surgery.
A 53-year-old man was readmitted with abdominal distention 2 weeks after undergoing laparoscopic low anterior resection with para-aortic lymphadenectomy for advanced rectal cancer (T4aN1M0, Stage IIIb). Ultrasound revealed massive ascites, and paracentesis revealed chylous fluid with a markedly elevated triglyceride level (1762 mg/dL). Despite conservative management, the fistula remained on postoperative day 120. On percutaneous lymphangiography, the chylous leakage point was clearly visualized at the para-aortic site, and surgical intervention was planned. The abdominal cavity was carefully explored with laparoscopy, and the lymphatic leakage point was detected at the site of previous lymphadenectomy. Leakage was stopped with direct suture ligation and fibrin glue, and the patient was discharged 2 weeks later with no recurrence of the chylous fistula. Surgical intervention can be effective in select patients with a major chylous fistula that persists despite conservative therapy. When the leakage point is localized and detectable on percutaneous lymphangiography, the laparoscopic approach may be feasible.
Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
Yudai
Y
Fukui
Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
Junichi
J
Shindoh
Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
Shuichiro
S
Matoba
Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
Kenji
K
Tomizawa
Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
Yutaka
Y
Hanaoka
Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
Shigeo
S
Toda
Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
Jin
J
Moriyama
Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
Hiroya
H
Kuroyanagi
D001011:Aorta; D002915:Chylous Ascites / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008026:Ligation; D008197:Lymph Node Excision; D042601:Lymphatic Vessels / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery*
Chylous ascites; laparoscopy; surgical treatment