Successful surgical treatment of two cases of congenital chylous ascites☆
Section snippets
Case 1
A baby girl, in whom fetal ascites were detected at 33 weeks' gestation, was born at 37 weeks' gestation by induction delivery weighing 3,526 g. Remarkable abdominal swelling was noted at birth. Her abdominal girth continued to increase after the start of feeding, and chylous ascites was diagnosed by abdominal paracentesis. The patient initially underwent conservative treatment with medium-chain triglyceride (MCT) milk and total parental nutrition (TPN). However, because her abdominal girth
Discussion
In congenital chylous ascites, because of a tendency for the condition to improve spontaneously and the difficulty in locating the area of chylous leakage by laparotomy, many surgeons have not performed surgical intervention. In the 103 Japanese case studies published by January 2001, 62 cases (63.9%) were cured by conservative treatment. The average treatment period among these cases was 63.5 days. Almost all cases cured by conservative treatment had an acute response to a treatment, and the
References (3)
- et al.
Chylous ascites: The first reported surgical cure by direct ligation
J Pediatr Surg
(1977)
Cited by (41)
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2022, Journal of Pediatric Surgery Case ReportsRetroperitoneal exploration with Vicryl mesh and fibrin tissue sealant for refractory chylous ascites
2019, Journal of Pediatric SurgeryCitation Excerpt :However, if endolymphatic interventions are unsuccessful, the next step is usually to attempt surgical ligation of the leak, with intraoperative localization using lipophilic dyes [3,7,15–21]. Many authors add fibrin glue application to the ligation strategy, particularly in cases where a specific site of lymphatic leak cannot be localized [3,6,16,19,22–24]. A diffuse field of small lymphatic microleaks can be extremely challenging to treat.
Chylothorax and chylous ascites: Management and pitfalls
2014, Seminars in Pediatric SurgeryCitation Excerpt :The closure of the leak can be reinforced with fibrin glue.61,62 Laparoscopy seems to be a promising approach for this procedure.63,64 CT was treated by direct approach of the TD and ligation years ago65 and this procedure, complemented with application of fibrin glue and sometimes pleurodesis, has been shown to be effective in the majority of newborns and small infants treated.45
Congenital chylous ascites: A report of a case treated with hemostatic cellulose and fibrin glue
2013, Journal of Pediatric SurgeryCitation Excerpt :Surgical treatment is reserved for cases that are unresponsive to medical treatment. The main purpose is to find a visible point of leakage in the abdominal lymphatic circulation, through which lymph leaks into the peritoneal cavity, that is amenable to surgical ligation [6,7]. Although, in theory, this approach appears attractive, from an empirical point of view, the observation of a single point of lymph leakage is often impracticable, particularly given that certain malformations appear as a surface from which lymph exudes.
Ascites
2012, Pediatric Surgery, 2-Volume Set: Expert Consult - Online and PrintAscites
2012, Pediatric Surgery
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Address reprint requests to Tetsuya Mitsunaga, Department of Pediatric Surgery, Chiba University School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677 Japan.