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Chylothorax and chylous ascites: management and pitfalls
Juan C Lopez-Gutierrez1, Juan A Tovar1
1Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain; Department of Pediatrics, Universidad Autonoma de Madrid, Madrid, Spain.
Seminars in Pediatric Surgery
|December 3, 2014
Summary
Chylothorax (CT) and chylous ascites (CA) result from lymphatic duct leakage. While often managed conservatively, persistent cases may require interventions like dietary changes, medication, or surgery.
Area of Science:
- Pediatrics
- Gastroenterology
- Cardiology
Background:
- Chylothorax (CT) and chylous ascites (CA) are conditions caused by lymphatic duct leakage.
- These conditions can occur congenitally or be acquired due to trauma, surgery, or other medical issues.
- Fetal CT and CA can be life-threatening, especially with fetal hydrops, sometimes necessitating intrauterine intervention.
Purpose of the Study:
- To summarize the causes, presentation, and management of chylothorax and chylous ascites.
- To highlight the spectrum of treatment options, from conservative measures to surgical interventions.
- To inform clinical practice regarding the diagnosis and treatment of these lymphatic leakage disorders.
Main Methods:
- Review of existing literature on chylothorax and chylous ascites.
- Analysis of clinical presentations, diagnostic challenges, and therapeutic outcomes.
- Discussion of conservative management, medical therapies, and surgical options.
Main Results:
- Most cases of CT and CA are managed with observation, rest, and supportive care.
- Nutritional support, including low-fat diets and parenteral nutrition, is crucial for decreasing fluid production.
- Pharmacological agents like somatostatin and octreotide have limited evidence of efficacy.
- Advanced interventions such as shunting, embolization, or ligation may be required for refractory cases.
Conclusions:
- Early recognition and appropriate management are key for favorable outcomes in CT and CA.
- A stepwise approach, starting with conservative measures and progressing to more invasive treatments if necessary, is recommended.
- Further research is needed to establish stronger evidence for the efficacy of certain medical therapies.
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