A RARE COMPLICATION OF ELECTIVE SIGMOID RESECTION

  • Daniel Ion “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania & Bucharest University Emergency Hospital, Bucharest, Romania
  • Dan Nicolae Păduraru “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania & Bucharest University Emergency Hospital, Bucharest, Romania
  • Octavian Andronic “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania & University Emergency Hospital, Bucharest, Romania
  • Claudia Nistor “Elias” University Emergency Hospital, Bucharest, Romania
  • Cosmin Palcău “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania & University Emergency Hospital, Bucharest, Romania
  • Răzvan Vasile Stoian Carol Davila University of Medicine and Pharmacy, Bucharest, Romania & University Emergency Hospital of Bucharest
  • Florentina Mușat “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania & University Emergency Hospital, Bucharest, Romania
  • Alexandra Bolocan “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania & University Emergency Hospital, Bucharest, Romania
Keywords: chylorrhea, post-operative complication, chylous drainage, lymphatic leakage

Abstract

There are many complications that can occur in the immediate post-operative period, but the implications of the lymphatic system are rarely an issue. Lymphatic leakage may present in many forms, all of them leading to chyle depletion. The nutritional, metabolic and immunologic implication of chyle pathological consumption are extremely severe and could be the cause of life-threatening situations when the drainage volume is more than 1000-1500 ml/day. Due to its rarity after abdominal surgery, it can become a problematic situation because of the lack of guidelines for this particular case. The overall management of post-operative chylorrhea is challenging, leading many times to re- interventions for surgical ligations or embolization, each coming with several other complications. Meanwhile, conservative treatment remains the first approach in treating lymphatic leakage whenever is possible. We present the case of a 75 years old patient who encounter recurrent episodes of chylorrhea after sigmoid resection.

References

[1] N. Unno et al., “Intraoperative lymph mapping with preoperative vein mapping to prevent postoperative lymphorrhea following paramalleolar bypass surgery in patients with critical limb ischemia.,” Surg. Today, vol. 44, no. 3, pp. 436–442, Mar. 2014, doi: 10.1007/s00595-013-0548-y.
[2] F. Ghezzi et al., “Lymphoceles, lymphorrhea, and lymphedema after laparoscopic and open endometrial cancer staging.,” Ann. Surg. Oncol., vol. 19, no. 1, pp. 259–267, Jan. 2012, doi: 10.1245/s10434-011-1854-5.
[3] G. S. Lausten and H. C. Engell, “Postoperative complications in abdominal vascular surgery.,” Acta Chir. Scand., vol. 150, no. 6, pp. 457–461, 1984.
[4] Y. Shibuya et al., “A novel therapeutic strategy for chylous ascites after gynecological cancer surgery: a continuous low-pressure drainage system.,” Arch. Gynecol. Obstet., vol. 287, no. 5, pp. 1005–1008, May 2013, doi: 10.1007/s00404-012-2666-y.
[5] T. Matsutani et al., “Transabdominal approach for chylorrhea after esophagectomy by using fluorescence navigation with indocyanine green.,” Case Rep. Surg., vol. 2014, p. 464017, 2014, doi: 10.1155/2014/464017.
[6] S. Lv et al., “A review of the postoperative lymphatic leakage.,” Oncotarget, vol. 8, no. 40, pp. 69062–69075, Sep. 2017, doi: 10.18632/oncotarget.17297.
[7] R. Bhardwaj, H. Vaziri, A. Gautam, E. Ballesteros, D. Karimeddini, and G. Y. Wu, “Chylous Ascites: A Review of Pathogenesis, Diagnosis and Treatment,” J. Clin. Transl. Hepatol., vol. 6, no. 1, pp. 105–113, Mar. 2018, doi: 10.14218/JCTH.2017.00035.
[8] S. S. Qureshi et al., “Chyle leak following surgery for abdominal neuroblastoma.,” J. Pediatr. Surg., vol. 51, no. 9, pp. 1557–1560, Sep. 2016, doi: 10.1016/j.jpedsurg.2015.11.002.
[9] E. A. Kim, H. Park, S. G. Jeong, C. Lee, J. M. Lee, and C. T. Park, “Octreotide therapy for the management of refractory chylous ascites after a staging operation for endometrial adenocarcinoma.,” J. Obstet. Gynaecol. Res., vol. 40, no. 2, pp. 622–626, Feb. 2014, doi: 10.1111/jog.12183.
[10] H. Y. Tiong, R. K. Goel, W. M. White, D. A. Goldfarb, and J. H. Kaouk, “Chylous ascites after laparoscopic donor nephrectomy.,” Asian J. Endosc. Surg., vol. 8, no. 1, pp. 34–39, Feb. 2015, doi: 10.1111/ases.12144.
[11] A. Jairath, A. Singh, A. Ganpule, S. Mishra, R. Sabnis, and M. Desai, “Management Protocol for Chylous Ascites After Laparoscopic Nephrectomy.,” Urology, vol. 86, no. 3, pp. 521–528, Sep. 2015, doi: 10.1016/j.urology.2015.06.001.
[12] W. Pan et al., “Incidence and risk factors of chylous ascites after pancreatic resection.,” Int. J. Clin. Exp. Med., vol. 8, no. 3, pp. 4494–4500, 2015.
[13] I. Giovannini, F. Giuliante, C. Chiarla, F. Ardito, M. Vellone, and G. Nuzzo, “Non-surgical management of a lymphatic fistula, after laparoscopic colorectal surgery, with total parenteral nutrition, octreotide, and somatostatin.,” Nutrition, vol. 21, no. 10, pp. 1065–1067, Oct. 2005, doi: 10.1016/j.nut.2005.04.003.
[14] J. Guyton, A; Hall, “Medical Physiology,” no. 11, pp. 190–192, 2006.
[15] C. Hoeffel, “A b d o m i n a l I m ag i n g • P i c t o r i a l E s s ay MR Lymphography of Abdominal and Retroperitoneal,” no. November, pp. 1051–1058, 2007, doi: 10.2214/AJR.07.2047.
[16] J. G. Evans et al., “Chylous ascites after post-chemotherapy retroperitoneal lymph node dissection: review of the M. D. Anderson experience.,” J. Urol., vol. 176, no. 4 Pt 1, pp. 1463–1467, Oct. 2006, doi: 10.1016/j.juro.2006.06.016.
[17] G. Scaletta et al., “Management of postoperative chylous ascites after surgery for ovarian cancer: a single-institution experience.,” Updates Surg., vol. 71, no. 4, pp. 729–734, Dec. 2019, doi: 10.1007/s13304-019-00656-x.
[18] H. Nishigori et al., “Postoperative chylous ascites after colorectal cancer surgery.,” Surg. Today, vol. 42, no. 8, pp. 724–728, Aug. 2012, doi: 10.1007/s00595-012-0132-x.
[19] Y. Owada et al., “[A Case Report of Chylous Ascites after Laparoscopic Sigmoid Colectomy Treated with Conservative Therapy].,” Gan To Kagaku Ryoho., vol. 45, no. 13, pp. 1866–1868, Dec. 2018.
[20] A. Matsumura et al., “[Two cases of chylous ascites after laparoscopic colorectal cancer surgery].,” Gan To Kagaku Ryoho., vol. 40, no. 12, pp. 1939–1941, Nov. 2013.
[21] M. Iłżecki, T. Zubilewicz, S. Przywara, and P. Terlecki, “The evaluation of the effectiveness of Tachosil in the treatment of lymphorrhea of the postoperative wound in the selected group of patients, after vascular reconstructive surgeries--preliminary report.,” Pol. Przegl. Chir., vol. 85, no. 12, pp. 687–692, Dec. 2013, doi: 10.2478/pjs-2013-0105.
[22] F. Benedix, H. Lippert, and F. Meyer, “[Post-surgical lymphocutaneous fistula, chylous ascites and chylothorax--infrequent but serious complications: etiology, diagnosis and therapeutic options].,” Zentralbl. Chir., vol. 132, no. 6, pp. 529–538, Dec. 2007, doi: 10.1055/s-2007-981364.
[23] P. Shao et al., “Laparoscopic extended pelvic lymph node dissection during radical cystectomy: technique and clinical outcomes.,” BJU Int., vol. 108, no. 1, pp. 124–128, Jul. 2011, doi: 10.1111/j.1464-410X.2010.09774.x.
[24] S.-J. Baek, S.-H. Kim, J.-M. Kwak, and J. Kim, “Incidence and risk factors of chylous ascites after colorectal cancer surgery.,” Am. J. Surg., vol. 206, no. 4, pp. 555–559, Oct. 2013, doi: 10.1016/j.amjsurg.2013.01.033.
[25] T. Matsuda, H. Fujita, Y. Kunimoto, T. Kimura, and K. Ogino, “Chylous ascites as a complication of laparoscopic colorectal surgery.,” Asian J. Endosc. Surg., vol. 6, no. 4, pp. 279–284, Nov. 2013, doi: 10.1111/ases.12057.
Published
2021-12-12
How to Cite
[1]
D. Ion, “A RARE COMPLICATION OF ELECTIVE SIGMOID RESECTION”, JSS, vol. 8, no. 3, Dec. 2021.