Chyloperitoneum after blunt abdominal injury

Area of Science:

• Trauma Surgery
• Gastroenterology
• Vascular Surgery

Background:

• Chylous leakage, particularly from blunt trauma, is an uncommon but serious injury.
• Mechanisms involve hyperextension or flexion leading to shearing of lymphatic vessels.

Purpose of the Study:

• To evaluate the incidence and management of chyle duct injuries resulting from blunt abdominal trauma.
• To present case studies and review literature on this rare condition.

Main Methods:

• Retrospective chart review of two patients with blunt trauma-induced chyle duct injury.
• Surgical exploration, intraoperative management with hemoclips and fibrin sealant.
• Literature review of similar cases of chylous retroperitoneum.

Main Results:

• Two patients with blunt trauma sustained lymphatic disruption; one pedestrian struck by car, another in a high-speed motor vehicle collision.
• Both patients were successfully treated with surgical clips, fibrin sealant, and specialized tube feedings.
• Complete resolution of chylous leakage was achieved with medium-chain triglyceride (MCT) tube feedings.

Conclusions:

• Chyle duct injury from blunt trauma is rare, with hyperextension/flexion as likely mechanisms.
• Surgical intervention (ligation/clipping) combined with MCT tube feedings appears effective for managing chylous leakage.
• Further investigation into the efficacy of MCTs in conjunction with surgical repair is warranted.