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CC BY 4.0 · J Reconstr Microsurg Open 2020; 05(01): e22-e26
DOI: 10.1055/s-0040-1710344
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Massive Chylous Ascites and Chylothorax Secondary to Chronic Pancreatitis: A Novel Surgical Option

Grace C. Lee
1   Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
,
Curtis L. Cetrulo
2   Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
,
Ashok Muniappan
3   Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
,
Kei Yamada
4   Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
,
Keith D. Lillemoe
1   Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
› Author Affiliations Funding G.C.L. received financial support from an NIH T32 grant (Research Training in Alimentary Tract Surgery, DK007754–13).
Further Information

Publication History

14 November 2019

20 March 2020

Publication Date:
21 May 2020 (online)

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Abstract

Background Chylous ascites is a debilitating condition characterized by milky, triglyceride-rich fluid accumulating in the peritoneum due to disruption of the intraabdominal lymphatic system. Medical management includes low-fat diets, somatostatin analogues, and therapeutic paracentesis, but is unsuccessful in one-third of patients.

Methods We present a 59-year-old man with massive chylous ascites and chylothorax secondary to chronic pancreatitis, who failed medical therapies for nearly two years, before being successfully treated with a novel surgical technique. Demographic and clinical data were obtained from the electronic medical record at Massachusetts General Hospital from 2015 to 2019. Patient information was kept anonymous and informed consent was obtained for publication of this report.

Results Based on a previously published small case series, we created a vascularized lymphatic cable flap based on the superior epigastric vessels, which we anastomosed to mesenteric vessels, permitting chylous drainage superiorly through the thoracic duct. With two years of follow-up, our patient has no evidence of recurrent ascites or chylothorax, and robust nutritional and functional status.

Conclusion We present this novel surgical technique as a promising intervention for patients with chylous ascites and/or chylothorax who have failed medical management.

Keywords

chylous ascites - chyle leak - lymphatic flap
 

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