Chylous ascites: a rare complication of vagotomy. Case report

A previously healthy 30-year-old man underwent vagotomy and pyloroplasty for a chronic duodenal ulcer that had not responded to H2 blockers. On the third day his abdomen was slightly distended; this gradually increased and on the eighth day ascites was confirmed by ultrasonography. Paracentesis yielded 4 litres of milky, odorless fluid. He was treated by fat free diet as he refused parenteral nutrition and on day 15 a further two litres of fluid were withdrawn, this time straw coloured. By day 31 his abdomen had returned to normal and his serum albumin concentration (which had dropped to 26 g/l) had risen to 43 g/l. He has now remained well for two years. Chylous ascites is a rare complication of truncal vagotomy, but should be suspected if postoperative ascites develops. Early recognition and treatment are important.