Case Report and Literature Review: Intraoperative Injury to Cisterna Chyli During an Elective Pancreatic Resection Leads to Chylous Ascites and a Poor Outcome

Case Report and Literature Review: Intraoperative Injury to Cisterna Chyli During an Elective Pancreatic Resection Leads to Chylous Ascites and a Poor Outcome

Waheeb Radman Al-Kubati,1 Hanan Rihani,2 Abdelaziz Zeadat2 1Surgery Department, 21st September University, Sana’a, Yemen; 2General Surgery, King Hussein Medical Centre, Amman, JordanCorrespondence: Ass. Prof. Waheeb Radman Al-Kubati, MBBS JBS ABS IMRCSI ASCRS ACPGBI ISID ISUCRS. Surgery Department,...

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Bibliographic Details
Main Authors: Al-Kubati WR, Rihani H, Zeadat A
Format: Article
Language:English
Published: Dove Medical Press 2023-04-01
Series:Open Access Surgery
Subjects:
background: chylous ascites is a rare condition. it develops as a result of iatrogenic injury to the cisterna chyli
thoracic duct
or their major tributaries. it leads to increase chyle release. subsequently obstruction of lymphatic return from abdomen. it is more prevalent after major abdominal procedures involving retro-peritoneum. case presentation: a 65 years old female patient was admitted with history of pain at epigastric and left upper abdominal quadrant via the emergency department at king hussein medical centre. she was planned for elective whipple’s procedure for cancer head of pancreas. this case report considers the impact of intraoperative injury to major lymphatic system leading to chylous ascites and death following her pancreatic resection. retrospective evaluation of her records
revealed an intraoperative iatrogenic injury to the cisterna chyli had occurred during whipple’s procedure. the injured lymphatic duct was discovered and repaired intraoperatively. the chyle drainage was resolved temporarily after three weeks of conservative management. despite its resolution
it recurred after massive upper gi bleeding which managed operatively after failed endoscopic and embolization. the patient failed to recover and died as a direct result of her poor general condition due to the effects of an iatrogenic injury of cisterna chyli. we report this case of intraoperative injury to the cisterna chyli
subsequent development of chylous ascites
and its post-operative sequelae. this article considers
even if discovered and repaired intraoperatively
the impact of such injury on development of postoperative chylous ascites
nutritional insufficiency
poor prognosis and subsequent death. conclusion: chylous ascites is a rare complication of whipple’s procedure. usually progresses due to iatrogenic operational trauma to the significant lymphatic channel. even if such injury to cisterna chyli is discovered and managed intraoperatively
it carries a poor prognosis and subsequent death.
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