Chyloperitoneum following abdominal aortic surgery

Vascular. 2008 Sep-Oct;16(5):258-62. doi: 10.2310/6670.2008.00035.

Abstract

Chyloperitoneum is an uncommon but serious complication following abdominal aortic surgery. As there seems to be no uniformity concerning the treatment, we performed a literature search to evaluate the best treatment results. All Medline-cited articles on chyloperitoneum after abdominal aortic surgery were assessed and analyzed. Thirty-eight cases of chyloperitoneum following abdominal aortic surgery were found. Patients developed symptoms after a median of 16 days (range 2-120 days) and were asymptomatic after 68 days (mean, range 27-93 years). All patients underwent diagnostic paracentesis, which confirmed the diagnosis. In 26 cases (68%), paracentesis was part of the treatment. The use of diuretics (24%) as therapeutic value was abandoned. Total parenteral nutrition, used in 21 patients (55%), provides the possibility of an extended period of oral starvation that reduces the lymphatic flow from the leaking duct. Medium-chain triglyceride, used in 28 cases (76%), is generally accepted as reducing lymphatic flow. When all conservative measures fail, surgical exploration is indicated. Two surgical interventions were mentioned: placing a peritoneovenous shunt or transfixing the damaged lymph vessel; both were described with different outcomes. This review supports conservative treatment of chyloperitoneum following abdominal aortic surgery.

Publication types

  • Review

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aorta, Abdominal / surgery*
  • Aortic Aneurysm, Abdominal / surgery
  • Aortic Rupture / surgery
  • Aortic Valve Stenosis / surgery
  • Chylous Ascites / diagnosis
  • Chylous Ascites / etiology*
  • Chylous Ascites / therapy
  • Female
  • Gastrointestinal Agents / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Octreotide / therapeutic use
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / therapy

Substances

  • Gastrointestinal Agents
  • Octreotide