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Chylous ascites following treatment for gynecologic malignancies
Tom P Manolitsas1, Shahab Abdessalam, Jeffrey M Fowler
1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The James Cancer Hospital and Solove Research Institute, Ohio State University College of Medicine, M-210 Starling Loving, 320 West 10th Avenue, Columbus, OH 43210-1228, USA.
Background:
Chylous ascites is a rare complication following abdominal radiation or para-aortic lymph node dissection in the management of gynecologic malignancies. Treatment options include dietary restriction with addition of medium-chain triglycerides, serial paracenteses, total parenteral nutrition, and somatostatin. Current opinion advocates that surgical exploration and peritoneo-venous shunts be reserved for refractory cases.
Cases:
Two patients developed chylous ascites, one after completion of surgical staging and chemoradiation for stage IIB squamous carcinoma of the cervix and one following para-aortic lymph node dissection for recurrent malignant mixed mullerian tumor of the endometrium. In both cases resolution of the chylous ascites followed placement of a peritoneo-venous shunt.
Conclusions:
Chylous ascites should be considered in the differential diagnosis of ascites in patients with gynecologic malignancy treated with radiation or para-aortic lymph node dissection.