Abstract
Refractory chylous ascites can cause significant nutritional and immunologic morbidity,
but no clear treatment has been established. This article introduces a case of a 22-year-old
female patient with an underlying lymphatic anomaly who presented with refractory
chylous ascites after laparoscopic adnexectomy for ovarian teratoma which aggravated
after thoracic duct embolization. Ascites (>3,000 mL/d) had to be drained via a percutaneous
catheter to relieve abdominal distention and consequent dyspnea, leading to significant
cachexia and weight loss. Two sessions of hybrid lymphovenous anastomosis (LVA) surgery
with intraoperative mesenteric lymphangiography guidance were performed to decompress
the lymphatics. The first LVA was done between inferior mesenteric vein and left para-aortic
enlarged lymphatics in a side-to-side manner. The daily drainage of chylous ascites
significantly decreased to 130 mL/day immediately following surgery but increased
6 days later. An additional LVA was performed between right ovarian vein and enlarged
lymphatics in aortocaval area in side-to-side and end-to-side manner. The chylous
ascites resolved subsequently without any complications, and the patient was discharged
after 2 weeks. The patient regained weight without ascites recurrence after 22 months
of follow-up. This case shares a successful experience of treating refractory chylous
ascites with lymphatic anomaly through LVA, reversing the patient's life-threatening
weight loss. LVA was applied with a multidisciplinary approach using intraoperative
mesenteric lipiodol, and results showed the possibility of expanding its use to challenging
problems in the intraperitoneal cavity.
Keywords chylous ascites - lymphangiography - lymphovenous anastomosis
