Successful laparoscopic ligation of the lymphatic trunk for refractory chylous ascites

A 3-year-old girl with recurrent chylous ascites was successfully treated by laparoscopic ligation of the ruptured lymphatic trunk. She was referred to our hospital at 16 days of age because of marked abdominal distension. Imaging methods showed massive ascites of unknown origin, and analysis of the ascites revealed its chylous nature. Conservative treatments were started. Her condition improved to some extent, and she was discharged. Two years later, she was readmitted with abdominal distension and loss of appetite. Laparoscopic surgery was planned to clarify the etiology and to treat intractable ascites. Sudan black B was orally administered, and laparoscopy revealed the presence of a whitish-gray fluid in the abdominal cavity, and a dark-blue stream of the dye was noticed. The responsible lesion of the chylous ascites was detected by tracking the stream. The lesion was ligated twice with an endoloop. She has been completely free from the symptoms for 3 years and 9 months. This experience indicates the usefulness of laparoscopic surgery in investigating the etiology of chylous ascites and treating it. The concomitant use of a lipophilic dye is mandatory to find the responsible lesion at surgery. Laparoscopic surgery, instead of open surgery, should be considered as a treatment of choice for intractable chylous ascites.