Complications of Retroperitoneal Lymphadenectomy
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
Chylous ascites is rare after RPLND occurring in 2% of patients. Indiana University reported on 18 (1.1%) patients developing chylous ascites after 1520 RPLND from 1965 to 1992 (5). Chylous ascites is the accumulation of chylomicron-laden lymphatic fluid in the peritoneal cavity. Chylous ascites can occur secondary to obstruction or disruption of the abdominal lymphatic channels. The cisterna chyli drains the lower body and liver and represents the confluence of the right and left lymphatic trunks of the retroperitonuem. The cisterna is located on the body of the second lumbar vertebra, medial and posterior to the aorta, by the side of the right crus of the diaphragm. It then continues through the aortic hiatus as the thoracic duct and ascends into the venous system at the junction of the left internal jugular and subclavian vein. Damage to the thoracic duct may lead to chylousthorax.
Ascites and Peritonitis
John F. Pohl, Christopher Jolley, Daniel Gelfond in Pediatric Gastroenterology, 2014
The most common cause for ascites in children is portal hypertension resulting from chronic liver disease (55.2, 55.3) or, less commonly, obstruction of hepatic vein outflow (as in Budd–Chiari syndrome) (Table 55.1). Other more common causes include pancreatitis, lymphatic obstruction, or trauma. Lymphatic disruption either from abdominal surgery, trauma, or neoplasms leads to chylous ascites (55.4, 55.5). Older children may also have traumatic extrahepatic perforation of the bile tree causing biliary ascites (55.6, 55.7). There have also been patients with ascites secondary to the following causes: right heart failure, constrictive pericarditis, intestinal necrosis (55.8), ventriculoperitoneal shunts (55.9, 55.10), intra-abdominal neoplasms such as lymphoma (55.11), Henoch–Schönlein purpura, Crohn disease (55.12, 55.13), and vitamin A toxicity.
Neonatal ascites
Prem Puri in Newborn Surgery, 2017
Chylous ascites is a rare condition seen during the newborn period and infancy; however, it is a challenging disorder with regard to its successful treatment. 15,16 Generally, it presents with abdominal distension with or without respiratory distress and occasional signs of peritoneal irritation and malabsorption.17 About 10% of all infants with chylous ascites have lymphedema of the limbs.18 The most common cause of chylous ascites (45%–60% of cases) is congenital malformation of the lymphatic channels such as atresia or stenosis of the major lacteals, mesenteric cysts, and generalized lymphangiomatosis. 16,19 Other causes are obstruction of the lymphatics from external compression, as in malrotation; incarcerated hernia; intussusception; and inflammatory enlargement of lymph nodes. Furthermore, blunt abdominal trauma, child abuse, and surgical injury are reported causes of chylous ascites.20
High mortality in peritonitis due to Mycobacterium avium complex: retrospective study and systematic literature review
Published in Infectious Diseases, 2019
Aurélie Baldolli, Claire Daurel, Renaud Verdon, Arnaud de La Blanchardière
In this report, we found that PMAC was associated with chylous ascites in 54% of cases. Chylous ascites is defined as an abnormal accumulation of triglyceride-rich lymphatic fluid in the peritoneal cavity, which makes the fluid milky. It is caused by the interruption of the lymphatic flow at any point from the intestinal villi to the left brachiocephalic vein (triggers may include surgical injury of the lymphatics, radiotherapy, lymphoma, gastric cancer, carcinoid tumours, Kaposi sarcoma, sarcoidosis, tuberculosis, filariasis and Whipple’s disease), increased lymph production (causes may include cirrhosis and constrictive pericarditis) or congenital dilated lymphatic vessels (causes may include intestinal lymphangiectasia, Klippel–Trenaunay syndrome and lymphangioma) [16,20,23,34,36]. In this review, most of the patients with chylous ascites were HIV-infected (n = 15, 88%) and all instances of IRIS related to MAC infection involved chylous ascites. For these patients, chylous ascites was probably secondary to the involvement of the retroperitoneal lymph nodes or to the obstruction or damage of lymphatic drainage [23,40]. It is also well known that HIV-related abdominal MAC-IRIS is associated with histologically granulomas, suggesting that for these five patients the pathogenesis of chylous ascites may be related to granulomatous lymphadenitis causing lymphatic obstruction at the base of the mesentery or the cisterna chili [33,44,45]. Chylous ascites was not reported in CAPD with PMAC which can be explained by the pathway of inoculation through the dialysate.
Chylous Ascites in an Infant with Thanatophoric Dysplasia Type I with FGFR3 Mutation Surviving Five Months
Published in Fetal and Pediatric Pathology, 2018
Jeon Soo-kyeong, Narae Lee, Mi Hye Bae, Young Mi Han, Kyung Hee Park, Shin Yun Byun
Only a few reports in the literature have described cases of patients who have survived beyond the neonatal period. Stensvold et al. (20) reported a 169 day survival, Tonoki (21) reported a 212 day survival, and Noe et al. reported 4 months survival (22). Of the patients who survive into adulthood, Nakai et al. (23) reported survival of 23 years and Nikkel et al. (24) reported survival of 26 years. All patients exhibited distinct developmental delay, severe growth deficiency, dependence on a ventilator, and skin disorders such as seborrheic keratoses and acanthosis nigricans. In our case, the patient showed accompanying chylous ascites, which was not previously reported. The patient’s condition improved following the switch to the MCT formula. Accordingly, CT, lymphangiography, or lymph node biopsies were not performed. The patient had no medical history of abdominal surgery, injury, infection, or liver cirrhosis, which are known causes of chylous ascites. There was a possibility that the patient had congenital abnormalities, such as lymphangiectasia, mesenteric cyst, or idiopathic leaky lymphatics, which are the most common causes of chylous ascites in pediatric patients. However, we could not ascertain this as the patient’s parents refused autopsy. It is difficult to determine if the chylous ascites was part of the TD deformity or just happened to accompany the TD.
The impact of portal vein thrombosis on the prognosis and liver function of nonmalignant cirrhotic patients
Published in Scandinavian Journal of Gastroenterology, 2018
Kei Endo, Takayoshi Oikawa, Keisuke Kakisaka, Akio Tamura, Shigeru Ehara, Yasuhiro Takikawa
A total of 137 medical containing the words ‘portal vein thrombosis,’ and ‘cirrhosis’ reports that were registered between June 2009 and June 2017 were identified from the electronic system. A total of 110 patients were excluded based on the exclusion criteria. The details of the patient selection are shown in Figure 1. Ultimately, 27 patients met the inclusion criteria. The clinical characteristics of the patients at registration are shown in Table 1. The location of PVT was the portal trunk in nine patients (33.3%), portal trunk to SMV in nine patients (33.3%), right main portal vein in three patients (11.1%), left main portal vein in four patients (14.8%) and SMV in two patients (7.4%). Fourteen patients (52%) complained of the new onset of symptoms when PVT was recognized. The symptoms were as follows: new or worsening ascites (n = 7), variceal bleeding (n = 4) and abdominal pain (n = 3). Thirteen patients had no new symptoms, and their PVT was diagnosed at routinely scheduled imaging studies.
Related Knowledge Centers
- Cirrhosis
- Shortness of Breath
- Spontaneous Bacterial Peritonitis
- Abdomen
- Peritoneal Cavity
- Tuberculosis
- Cancer
- Shortness of Breath
- Heart Failure
- Pancreatitis
- Budd–Chiari Syndrome