Benjamin D Carr1, Christa N Grant2, Richard E Overman3, Samir K Gadepalli4, James D Geiger5. 1. Department of Surgery, Division of Pediatric Surgery, University of Michigan, 1540 E Hospital Dr. SPC 4217, Ann Arbor, MI 48109, United States. Electronic address: bdecarr@med.umich.edu. 2. Department of Surgery, Division of Pediatric Surgery, University of Michigan, 1540 E Hospital Dr. SPC 4217, Ann Arbor, MI 48109, United States. Electronic address: gchrista@med.umich.edu. 3. Department of Surgery, Division of Pediatric Surgery, University of Michigan, 1540 E Hospital Dr. SPC 4217, Ann Arbor, MI 48109, United States. Electronic address: rioverma@med.umich.edu. 4. Department of Surgery, Division of Pediatric Surgery, University of Michigan, 1540 E Hospital Dr. SPC 4217, Ann Arbor, MI 48109, United States. Electronic address: samirg@med.umich.edu. 5. Department of Surgery, Division of Pediatric Surgery, University of Michigan, 1540 E Hospital Dr. SPC 4217, Ann Arbor, MI 48109, United States. Electronic address: jgeiger@med.umich.edu.
Abstract
BACKGROUND: Congenital chylous ascites poses a significant challenge in neonatal care, and often results in prolonged, complex hospital stays and increased mortality. Few effective options exist in refractory cases. METHODS: Patients aged 0 to 12 months with refractory chylous ascites underwent retroperitoneal exploration after medical treatment and minimally invasive therapies were unsuccessful. The retroperitoneum was completely exposed via left and right medial visceral rotation and opening the lesser sac. Visible leaks were ligated, and alternating layers of fibrin glue and Vicryl mesh were used to cover the entire retroperitoneum. RESULTS: All 4 patients had resolution of their chylous ascites. None required reoperation or reintervention for chyle leaks. All achieved goal enteral feeds at a median of 29 days postoperatively and were discharged from hospital at a median of 42 days postoperatively. CONCLUSIONS: Management of chylous ascites is extremely challenging in refractory cases. Complete retroperitoneal exposure with fibrin glue and Vicryl mesh application offers a definitive, reliable therapy for achieving cessation of lymphatic leakage and ultimate recovery for patients who fail all nonoperative approaches. STUDY TYPE: Therapeutic. LEVEL OF EVIDENCE: IV.
BACKGROUND:Congenital chylous ascites poses a significant challenge in neonatal care, and often results in prolonged, complex hospital stays and increased mortality. Few effective options exist in refractory cases. METHODS:Patients aged 0 to 12 months with refractory chylous ascites underwent retroperitoneal exploration after medical treatment and minimally invasive therapies were unsuccessful. The retroperitoneum was completely exposed via left and right medial visceral rotation and opening the lesser sac. Visible leaks were ligated, and alternating layers of fibrin glue and Vicryl mesh were used to cover the entire retroperitoneum. RESULTS: All 4 patients had resolution of their chylous ascites. None required reoperation or reintervention for chyle leaks. All achieved goal enteral feeds at a median of 29 days postoperatively and were discharged from hospital at a median of 42 days postoperatively. CONCLUSIONS: Management of chylous ascites is extremely challenging in refractory cases. Complete retroperitoneal exposure with fibrin glue and Vicryl mesh application offers a definitive, reliable therapy for achieving cessation of lymphatic leakage and ultimate recovery for patients who fail all nonoperative approaches. STUDY TYPE: Therapeutic. LEVEL OF EVIDENCE: IV.
Authors: Robert G Dionisio; Kevin Sh Koo; Elizabeth Ry Tang; Mark R Ferguson; Eric J Monroe; Joseph Reis; Giridhar M Shivaram; Caitlin A Smith Journal: Radiol Case Rep Date: 2020-11-13