Laparoscopic management of the congenital chylous ascites in a newborn: Case report
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作者:
Zahradnikova, Petra
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Comenius Univ, Natl Inst Childrens Dis Bratislava, Fac Med, Dept Paediat Surg, Bratislava, Slovakia
Comenius Univ, Fac Med, Dept Pediat Surg, Bratislava, Slovakia
Natl Inst Childrens Dis, Bratislava, SlovakiaComenius Univ, Natl Inst Childrens Dis Bratislava, Fac Med, Dept Paediat Surg, Bratislava, Slovakia
Zahradnikova, Petra
[1
,3
,4
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Pechanova, Rebeka
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Comenius Univ, Natl Inst Childrens Dis Bratislava, Fac Med, Dept Paediat Surg, Bratislava, SlovakiaComenius Univ, Natl Inst Childrens Dis Bratislava, Fac Med, Dept Paediat Surg, Bratislava, Slovakia
Pechanova, Rebeka
[1
]
Fedorova, Lenka
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Comenius Univ, Natl Inst Childrens Dis Bratislava, Fac Med, Dept Paediat Surg, Bratislava, SlovakiaComenius Univ, Natl Inst Childrens Dis Bratislava, Fac Med, Dept Paediat Surg, Bratislava, Slovakia
Fedorova, Lenka
[1
]
Jager, Rene
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Comenius Univ, Natl Inst Childrens Dis Bratislava, Fac Med, Dept Paediat Surg, Bratislava, SlovakiaComenius Univ, Natl Inst Childrens Dis Bratislava, Fac Med, Dept Paediat Surg, Bratislava, Slovakia
Jager, Rene
[1
]
Nedomova, Barbora
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Comenius Univ, Natl Inst Childrens Dis Bratislava, Fac Med, Dept Paediat Anaesthesiol & Intens Med, Bratislava, SlovakiaComenius Univ, Natl Inst Childrens Dis Bratislava, Fac Med, Dept Paediat Surg, Bratislava, Slovakia
Nedomova, Barbora
[2
]
Babala, Jozef
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Comenius Univ, Natl Inst Childrens Dis Bratislava, Fac Med, Dept Paediat Surg, Bratislava, SlovakiaComenius Univ, Natl Inst Childrens Dis Bratislava, Fac Med, Dept Paediat Surg, Bratislava, Slovakia
Babala, Jozef
[1
]
机构:
[1] Comenius Univ, Natl Inst Childrens Dis Bratislava, Fac Med, Dept Paediat Surg, Bratislava, Slovakia
[2] Comenius Univ, Natl Inst Childrens Dis Bratislava, Fac Med, Dept Paediat Anaesthesiol & Intens Med, Bratislava, Slovakia
[3] Comenius Univ, Fac Med, Dept Pediat Surg, Bratislava, Slovakia
Congenital chylous ascites (CCA) is a rare condition seen in the neonatal period. The pathogenesis is primarily related to congenital intestinal lymphangiectasis. Conservative treatment of chylous ascites involves paracentesis, total parenteral nutrition (TPN), medium-chain triglyceride (MCT)-based milk formula, use of somatostatin analogue and octreotide. Surgical treatment is considered when conservative treatment fails. We describe a laparoscopic treatment of CCA using the fibrin glue technique. A male infant, in whom foetal ascites was detected at 19 weeks of gestation, was born by caesarean section at 35 weeks of gestation weighing 3760 g. There was evidence of hydrops in the foetal scan. A diagnosis of chylous ascites was made by abdominal paracentesis. A magnetic resonance scan was suggestive of gross ascites, and no lymphatic malformation was identified. TPN and octreotide infusion was started and continued for 4 weeks, but the ascites persisted. The failure of conservative treatment led us to perform laparoscopic exploration. Intraoperatively, chylous ascites and multiple prominent lymphatic vessels around the root of the mesentery were noted. The fibrin glue was applied over the leaking mesenteric lymphatic vessels in the duodenopancreatic region. Oral feeding was started from post-operative day 7. After 2 weeks of the MCT formula, ascites progressed. Thus, laparoscopic exploration was necessary. We introduced an endoscopic applicator for fibrin glue and applied it into the place of leakage. The patient was doing well with no appearance of ascites reaccumulating and was discharged on the 45th post-operative day. Follow-up ultrasonography (1st, 3rd and 9th months after discharge) showed a small amount of ascitic fluid but with no clinical significance. Laparoscopic localisation and ligation of leakage sites could be difficult, especially in newborns and young infants due to the small size of lymphatic vessels. The use of fibrin glue to seal the lymphatic vessels is quite promising.
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King Abdullah Med City, Dept Specialized Surg, Mecca, Saudi ArabiaKing Abdullah Med City, Dept Specialized Surg, Mecca, Saudi Arabia
Khogeer, Alwahhaj
Elbahrawy, Aly
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King Abdullah Med City, Dept Specialized Surg, Mecca, Saudi Arabia
Alexandria Univ, Med Res Inst, Dept Surg, Alexandria, EgyptKing Abdullah Med City, Dept Specialized Surg, Mecca, Saudi Arabia
Elbahrawy, Aly
Almontashery, Ali
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King Abdullah Med City, Dept Specialized Surg, Mecca, Saudi ArabiaKing Abdullah Med City, Dept Specialized Surg, Mecca, Saudi Arabia
机构:
Lanzhou Univ, Sch Clin Med 1, Lanzhou, Gansu, Peoples R China
First Hosp Lanzhou Univ, Dept Gastroenterol, Lanzhou, Gansu, Peoples R ChinaLanzhou Univ, Sch Clin Med 1, Lanzhou, Gansu, Peoples R China
Nie, Rui
Gao, Jie
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Lanzhou Univ, Sch Clin Med 1, Lanzhou, Gansu, Peoples R China
First Hosp Lanzhou Univ, Dept Gastroenterol, Lanzhou, Gansu, Peoples R ChinaLanzhou Univ, Sch Clin Med 1, Lanzhou, Gansu, Peoples R China
Gao, Jie
Yang, Wei
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First Hosp Lanzhou Univ, Dept Gastroenterol, Lanzhou, Gansu, Peoples R ChinaLanzhou Univ, Sch Clin Med 1, Lanzhou, Gansu, Peoples R China
Yang, Wei
Lu, Hong
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Lanzhou Univ, Sch Clin Med 1, Lanzhou, Gansu, Peoples R China
First Hosp Lanzhou Univ, Dept Gastroenterol, Lanzhou, Gansu, Peoples R China
Lanzhou Univ, Key Lab Gastrointestinal Dis Gansu Prov, Lanzhou, Gansu, Peoples R ChinaLanzhou Univ, Sch Clin Med 1, Lanzhou, Gansu, Peoples R China
Lu, Hong
Ren, Qian
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Lanzhou Univ, Sch Clin Med 1, Lanzhou, Gansu, Peoples R China
First Hosp Lanzhou Univ, Dept Gastroenterol, Lanzhou, Gansu, Peoples R China
Lanzhou Univ, Key Lab Gastrointestinal Dis Gansu Prov, Lanzhou, Gansu, Peoples R ChinaLanzhou Univ, Sch Clin Med 1, Lanzhou, Gansu, Peoples R China