Iatrogenic Chylous Ascites: Case Report

Activity: Talk or presentation types › Poster presentation

Description

Chylous ascites (CA) is a rare condition due to malignancy, cirrhosis or lymphatic disruption after abdominal surgery. Patients should receive low-fat diet and orlistat, somatostatin as first line, combined with minimal-invasive interventions. Surgical is the last intervention. Aim is to present iatrogenic chylous ascites as a rare complication after lymph node biopsy. A 42-years-old female was admitted to university hospital in intensive care unit (ICU) due to refractory ascites, acute renal failure and severe electrolyte imbalance in November 2022. It is known that patient had anamnesis of asymptomatic chronic virus hepatitis C (2004) and radical hysterectomy (2019). Two-months prior hospitalization patient underwent laparoscopic intrabdominal lymph node biopsy (August 2022). Not either malignancy in uterus not in lymph nodes where histologically confirmed. One week after the biopsy increasing fatigue and abdominal swelling appeared. Patient was repeatedly four times admitted to the hospital over a seven-week period and ascites 25 liters was evacuated. Nevertheless, condition continued to deteriorate. At current hospitalization the patient with suspected sepsis, acute renal failure, massive chylous ascites was admitted in ICU with severe hypoalbuminemia(14,2g/l) presenting general edema and severe exicosis, with critical urea, potassium, Hb and Creatinine values. Laparocentesis revealed milky-white ascites (plasma triglyceride ratio 4:1) without malignant cells and negative culture. Length of stay in ICU was 1.5 months, where patient received low-fat diet, somatostatin, parenteral nutrition, electrolyte correction and rehydration. Lymphangiography, lymphoscintigraphy and diagnostic laparoscopy not succeed to find the area of lymph leakage. For one month the patient lost 63 liters of lymph through laparocentesis. Now a peritoneovenosus shunt is considered as the next step. The main challenge of this case was to identify the iatrogenic rupture in the lymphatic system and to precisely compensate loss of lymph in major amounts consisting of hight concentration of life threating substances.. .. .. .
Period29 Mar 2023
Event titleRSU International Research Conference 2023: Knowledge for Use in Practice
Event typeConference
OrganiserRīga Stradiņš University
LocationRiga, LatviaShow on map
Degree of RecognitionInternational

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