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Postoperative chylous ascites after radical gastrectomy. A case report
N Halkic1, A Abdelmoumene, L Suardet
1Service de Chirurgie, CHUV, Lausanne, Switzerland. Nermin.Halkic@chuv.hospvd.ch
Minerva Chirurgica
|September 5, 2003
Summary
Postoperative chylous ascites is a rare complication after gastrectomy. Conservative management, including parenteral nutrition and a fat-free diet, effectively resolved the condition in this case.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Abdominal Surgery
Background:
- Postoperative chylous ascites (PCA) is an uncommon complication following extensive abdominal surgery, particularly retroperitoneal or mesenteric dissections.
- The incidence of PCA ranges from 1.2% to 3%, with rare occurrences reported after specific gastric surgeries like ulcer surgery with vagotomy or gastrectomy.
Observation:
- This report details the second case of PCA following a D2 distal gastrectomy for adenocarcinoma.
- A 56-year-old female patient developed PCA after undergoing D2 distal gastrectomy, gastro-duodenostomy, and omentectomy for a T1N0M0 adenocarcinoma.
Findings:
- The patient was managed conservatively with parenteral nutrition and a fat-free diet.
- Chylous effusion resolved by the second postoperative week, with drain removal on the 20th postoperative day and successful resumption of enteral nutrition without recurrence.
Implications:
- Conservative management, including nutritional support and dietary modifications, is an effective first-line treatment for postoperative chylous ascites, achieving resolution in approximately 60% of cases.
- This case reinforces the efficacy of conservative strategies for managing this rare but significant surgical complication.
