Chylous Ascites Following Abdominal Aortic Aneurysm Repair

A woman aged 75 years developed chylous ascites day 5 after emergency abdominal aortic aneurysm repair. She was still on artificial ventilation at the time of diagnosis. The first symptoms were high ventilation pressure, an elevated diaphragm, and abdominal distention. The patient was treated conservatively with drainage and total parenteral nutrition and given tube feeding without long-chain triglycerides. Unfortunately, the patient died of sepsis on day 25. Chylous ascites is an unusual complication of retroperitoneal surgery. Abdominal paracentesis is a simple means to confirm the diagnosis. Initial treatment consists of draining the chylus and a medium-chain triglyceride diet or total parenteral nutrition. When this fails, more invasive treatment is required, consisting of direct lymphatic repair or peritoneovenous shunting. In mechanically ventilated patients, gradually progressive symptoms of abdominal hypertension after surgery in the retroperitoneal space should arouse suspicion of this complication.