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Chylous ascites following abdominal aortic surgery
E Panieri1, B D Kussman, W L Michell
1Department of Surgery, Groote Schuur Hospital.
Summary
Chylous ascites, a rare complication of abdominal aortic surgery, can cause significant nutritional and respiratory issues. Early diagnosis via paracentesis and conservative management, including dietary changes and medium-chain triglycerides (MCT), are key to successful outcomes.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Critical Care Medicine
Background:
- Chylous ascites is an exceptionally rare complication following abdominal aortic surgery.
- It can lead to severe nutritional imbalance, immunological compromise, and respiratory compromise.
Observation:
- A case of chylous ascites post-abdominal aortic surgery with a successful outcome is presented.
- A review of 17 previously published cases is included.
Findings:
- Diagnosis is confirmed by paracentesis, which also offers symptomatic relief.
- Conservative management, starting with a low-fat diet and medium-chain triglyceride (MCT) supplementation, is the recommended initial approach.
- Total parenteral nutrition is considered if conservative measures fail.
Implications:
- Failure of non-operative management may require surgical intervention, such as ligation of leaking lymphatics or peritoneovenous shunting.
- This case highlights the importance of recognizing and managing this rare but serious complication.
- Effective management strategies are crucial for patient recovery and preventing long-term sequelae.