Postoperative Chylous Ascites in Gynecological Malignancies: Case report
Chylous ascites (CA) is a rare condition caused by disruption of the lymphatic system, with the accumulation of milky triglyceride-rich chyle in the peritoneal cavity. Multiple etiologies have been reported, including traumatic, congenital, infectious, neoplastic, postoperative, cirrhotic, or cardiogenic.
The symptoms of CA are nonspecific. The most typical feature is abdominal distention, followed by indigestion, nausea, and vomiting. The severity depends on the amount of ascitic fluid and its accumulation rate, as well as the patient’s health condition. Serious cases of peritonitis and ileus have also been reported. In some cases, deterioration with environmental disturbances and immunological dysfunctions have also been reported. Treatment strategies for postoperative CA are broadly divided into two categories, namely, conservative management (dietary restriction and medical therapy) and surgery. Conservative management, which aimed to reduce the production of chyle and promote closure of the fistula, is successful in most cases. Surgical intervention is usually performed following unsuccessful conservative management.
Postoperative CA is infrequent after gynecological surgery. Most available studies are case reports. Experience in the prevention, diagnosis, and treatment of postoperative CA is lacking. Here, authors described two cases of postoperative CA following gynecological surgeries and reviewed the relevant articles on patients with gynecological malignancies and postoperative CA. This study aimed to describe the clinical features of CA after gynecological surgery and to determine the potential factors associated with its prognosis.
Authors reported two cases of postoperative CA following gynecological surgery and reviewed the clinical features of 140 patients from 16 relevant papers. Patients’ clinicopathological characteristics, surgical approach, and management were summarized. The onset and resolution times of postoperative CA in different groups were analyzed separately.
The two patients in our report had recovery after conservative treatments. According to the literature review, the median time of onset of postoperative CA was 5 days (range, 0–75 days) after surgery. The median resolution time was 9 days (range, 2–90 days). Among patients, 87.14% of them had lymphadenectomy during gynecological surgeries, while 92.86% of the patients had resolution after conservative treatments.
The current study consists of two parts. First, authors reported two cases of postoperative CA caused by gynecological surgeries and described our experience with successful conservative treatment. Then, they reviewed 16 studies that included 140 patients with postoperative CA. Lymphadenectomy during surgery may be relevant to the occurrence of postoperative CA. Once diagnosed, conservative management could be the initial choice for postoperative CA treatment, and most patients could get resolution from it.
Source: Xin Tan et al.; Wiley Obstetrics and Gynecology International Volume 2024, Article ID 1810634, 12 pages https://doi.org/10.1155/2024/1810634
