Hybrid Lymphovenous Anastomosis Surgery Guided by Intraoperative Mesenteric Intranodal Lymphangiography for Refractory Nontraumatic Chylous Ascites: A Case Report
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 ad...
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| Format: | Article |
| Language: | English |
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Thieme Medical Publishers, Inc.
2024-01-01
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| Series: | Archives of Plastic Surgery |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-1776304 |
| _version_ | 1827338190419132416 |
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| author | Soo Jin Woo Saebeom Hur Hee Seung Kim Hak Chang Ji-Young Kim Soo Jin Park Ung Sik Jin |
| author_facet | Soo Jin Woo Saebeom Hur Hee Seung Kim Hak Chang Ji-Young Kim Soo Jin Park Ung Sik Jin |
| author_sort | Soo Jin Woo |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-07T19:11:08Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2234-6163 2234-6171 |
| language | English |
| last_indexed | 2024-03-07T19:11:08Z |
| publishDate | 2024-01-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | Archives of Plastic Surgery |
| spelling | doaj.art-3d017843229847faa30f228d873bdfe92024-03-01T00:10:26ZengThieme Medical Publishers, Inc.Archives of Plastic Surgery2234-61632234-61712024-01-01510113013410.1055/s-0043-1776304Hybrid Lymphovenous Anastomosis Surgery Guided by Intraoperative Mesenteric Intranodal Lymphangiography for Refractory Nontraumatic Chylous Ascites: A Case ReportSoo Jin Woo0https://orcid.org/0000-0003-3476-8133Saebeom Hur1https://orcid.org/0000-0003-0787-5101Hee Seung Kim2https://orcid.org/0000-0001-6876-8671Hak Chang3https://orcid.org/0000-0002-9888-1787Ji-Young Kim4https://orcid.org/0000-0003-1932-565XSoo Jin Park5https://orcid.org/0000-0002-7382-230XUng Sik Jin6https://orcid.org/0000-0001-5096-6207Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of KoreaDepartment of Radiology, Seoul National University College of Medicine, Seoul, Republic of KoreaDepartment of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of KoreaDepartment of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of KoreaDepartment of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of KoreaDepartment of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of KoreaDepartment of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of KoreaRefractory 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.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-1776304chylous asciteslymphangiographylymphovenous anastomosis |
| spellingShingle | Soo Jin Woo Saebeom Hur Hee Seung Kim Hak Chang Ji-Young Kim Soo Jin Park Ung Sik Jin Hybrid Lymphovenous Anastomosis Surgery Guided by Intraoperative Mesenteric Intranodal Lymphangiography for Refractory Nontraumatic Chylous Ascites: A Case Report Archives of Plastic Surgery chylous ascites lymphangiography lymphovenous anastomosis |
| title | Hybrid Lymphovenous Anastomosis Surgery Guided by Intraoperative Mesenteric Intranodal Lymphangiography for Refractory Nontraumatic Chylous Ascites: A Case Report |
| title_full | Hybrid Lymphovenous Anastomosis Surgery Guided by Intraoperative Mesenteric Intranodal Lymphangiography for Refractory Nontraumatic Chylous Ascites: A Case Report |
| title_fullStr | Hybrid Lymphovenous Anastomosis Surgery Guided by Intraoperative Mesenteric Intranodal Lymphangiography for Refractory Nontraumatic Chylous Ascites: A Case Report |
| title_full_unstemmed | Hybrid Lymphovenous Anastomosis Surgery Guided by Intraoperative Mesenteric Intranodal Lymphangiography for Refractory Nontraumatic Chylous Ascites: A Case Report |
| title_short | Hybrid Lymphovenous Anastomosis Surgery Guided by Intraoperative Mesenteric Intranodal Lymphangiography for Refractory Nontraumatic Chylous Ascites: A Case Report |
| title_sort | hybrid lymphovenous anastomosis surgery guided by intraoperative mesenteric intranodal lymphangiography for refractory nontraumatic chylous ascites a case report |
| topic | chylous ascites lymphangiography lymphovenous anastomosis |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-1776304 |
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