Chylous Ascites Following Laparoscopic Donor Nephrectomy: Report of a Case and a Brief Overview

被引:0
作者
Sheela, Chithra Sugathan [1 ]
Thomas, Renu [1 ]
Yadav, Manish Kumar [2 ]
Sasidharan, K. [1 ]
机构
[1] KIMSHEALTH, Dept Urol, Thiruvananthapuram, Kerala, India
[2] KIMSHEALTH, Dept Imaging & Intervent Radiol, Thiruvananthapuram, Kerala, India
关键词
Chyle leak; chylous ascites; laparoscopic donor nephrectomy; lymphatic embolization;
D O I
10.4103/ijot.ijot_67_22
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Postoperative chylous ascites is a well-known complication of retroperitoneal lymph node dissection for testicular malignancies. This complication is now being reported increasingly with laparoscopic nephrectomies as well. A 33-year-old woman with no comorbidities underwent laparoscopic left donor nephrectomy. She had an uneventful postoperative recovery and was discharged on the 5th postoperative day. She reported on the 11th postoperative day with abdominal distension. Clinical examination revealed free fluid in the peritoneal cavity, and she was evaluated further. Imaging revealed mild ascites, which was aspirated, yielding milky fluid. Biochemical analysis of the fluid revealed triglycerides and chylomicrons, consistent with chyle. She was admitted, and an intra-abdominal drain placed under ultrasound guidance. Subsequently, she underwent lymphangiography and embolization. Her drain output came down, and she remained asymptomatic following drain removal. There was no further chylous leak on subsequent follow-up. Chylous ascites following laparoscopic nephrectomy is more common on the left side. Chylous leaks have been attributed to incomplete sealing of lymphatics with energy devices. Precise surgical technique of division of lymphatics between clips can prevent this complication. Most small leaks settle with a conservative care. Those that do not settle require open ligation. Percutaneous lymphatic embolization is an effective minimally invasive modality in managing such patients.
引用
收藏
页码:114 / 116
页数:3
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