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TÜRKÇE
Oral Presentation - 126
Chylous Ascitis- Unusual complication in cases of EHPVO after shunt surgery
Pooja Prajapati, Vijai Datta Upadhyaya, Rahul Goel
sanjay gandhi post graduate institute of medical sciences, lucknow, india
Introduction: Chylous ascites (CA) is a rare postoperative complication. The accumulation of chylous fluid in the abdominal cavity is an infrequent yet alarming complication in abdominal surgery. Excessive lymphatic leakage is ocassionally encountered in the course of operation at the base of mesentery or retroperitoneum. This study aims to evaluate the incidence and risk factors of CA following shunt surgery in cases of Extrahepatic portal venous obstruction (EHPVO).
Materials and methods: Electronic medical records of the patients underwent shunt surgery for various indications in EHPVO were reviewed retrospectively from January 2019 to March 2024. Demographic data, radiological data, operative notes and postoperative management reviewed retrospectively. The diagnosis of CA was based on the presence of a non-infectious milky or creamy peritoneal fluid greater than 100 ml/day with a triglyceride concentration ≥110 mg/dl.
Results: 64 patients were operated for EHPVO in a single unit during the study period. Total of 14 patients (21.8 %) with mean age of 11.8 years (9 males and 5 females), developed ascites needing abdominal drain for prolonged period (mean-16.6 days). Out of which, 5 patients (7.8 %) had CA on clinical and biochemical evaluation. It is more common in the patients with raised portal pressure (mean-46.6 cm H2O), after intrapancreatic splenic vein dissection (for small splenic vein), pericholedochal cholangiopathy, large retroperitoneal or perisplenic collateralls dissection. All the patients were treated conservatively for ascites with peritoneal drainage, medium chain triglyceride diet (MCT), octeriotide infusion and TPN administration. All the patients are on regular follow up and are doing well.
Conclusion: Chylous ascites is a rare and unusual complication following Shunt surgery. The risk is mainly predicted by the extent of dissection and surgery. CA may cause significant morbidity and prolong length of hospital stay. Conservative treatment with peritoneal drainage, MCT based diet modification, Octeriotide infusion intend to reduce the flow of lymph is recommended to avoid complications.