Postoperative Chylous Ascites in Gynecological Malignancies: Case report
Chylous ascites (CA) is a rare condition caused by
disruption of the lymphatic system, with the accumulation of milky
triglyceride-rich chyle in the peritoneal cavity. Multiple etiologies have been
reported, including traumatic, congenital, infectious, neoplastic,
postoperative, cirrhotic, or cardiogenic.
The symptoms of CA are nonspecific. The most typical feature
is abdominal distention, followed by indigestion, nausea, and vomiting. The
severity depends on the amount of ascitic fluid and its accumulation rate, as
well as the patient’s health condition. Serious cases of peritonitis and ileus
have also been reported. In some cases, deterioration with environmental
disturbances and immunological dysfunctions have also been reported. Treatment
strategies for postoperative CA are broadly divided into two categories,
namely, conservative management (dietary restriction and medical therapy) and
surgery. Conservative management, which aimed to reduce the production of chyle
and promote closure of the fistula, is successful in most cases. Surgical
intervention is usually performed following unsuccessful conservative
management.
Postoperative CA is infrequent after gynecological surgery.
Most available studies are case reports. Experience in the prevention,
diagnosis, and treatment of postoperative CA is lacking. Here, authors
described two cases of postoperative CA following gynecological surgeries and
reviewed the relevant articles on patients with gynecological malignancies and
postoperative CA. This study aimed to describe the clinical features of CA
after gynecological surgery and to determine the potential factors associated
with its prognosis.
Authors reported two cases of postoperative CA following
gynecological surgery and reviewed the clinical features of 140 patients from
16 relevant papers. Patients’ clinicopathological characteristics, surgical
approach, and management were summarized. The onset and resolution times of
postoperative CA in different groups were analyzed separately.
The two patients in our report had recovery after
conservative treatments. According to the literature review, the median time of
onset of postoperative CA was 5 days (range, 0–75 days) after surgery. The
median resolution time was 9 days (range, 2–90 days). Among patients, 87.14% of
them had lymphadenectomy during gynecological surgeries, while 92.86% of the
patients had resolution after conservative treatments.
The current study consists of two parts. First, authors
reported two cases of postoperative CA caused by gynecological surgeries and
described our experience with successful conservative treatment. Then, they
reviewed 16 studies that included 140 patients with postoperative CA.
Lymphadenectomy during surgery may be relevant to the occurrence of
postoperative CA. Once diagnosed, conservative management could be the initial
choice for postoperative CA treatment, and most patients could get resolution
from it.
Source: Xin Tan et al.; Wiley Obstetrics and Gynecology
International Volume 2024, Article ID 1810634, 12 pages