Postoperative chylous ascites: diagnosis and treatment. A series report and literature review.

The accumulation of chylous fluid in the abdominal cavity is an infrequent yet alarming complication in abdominal surgery. Excessive lymphatic leakage is occasionally encountered in the course of operations at the base of the mesentery or retroperitoneum. A source can usually be identified and the leak controlled at the time of laparotomy by suture or clip. In the region of presumed leakage the importance of these efforts is reinforced by the are patient in whom such leakage persists, creating problems in recognition and management postoperatively. The development of this complication in a patient undergoing total abdominal colectomy and left-sided hepatic lobectomy prompted a review of our experience and a literature review. We report four cases of postoperative chylous ascites seen over 5 years. The fluid accumulation followed operations on the abdominal aorta (two patients) and on the colon and liver (one patient) and after a mesocaval shunt procedure (one patient). Two patients responded to low-fat, medium-chain triglyceride diets; one patient required peritoneovenous shunting; and one patient died of progressive nutritional deterioration. We review the recognition and management of chylous ascites based on our experience and that reported elsewhere.