A Case Report of Chylous Ascites after Pylorus Preserving Pancreatoduodenectomy

Kei Mizuguchi, Hiromi Tokumura, Takafumi Sato, Yoichi Imaoka, Akio Ouchi, Kyoji Yamamoto, Takashi Matsushiro

Department of Surgery, Tohoku Rosai Hospital

A 54-year-old man underwent pylorus preserving pancreatoduodenectomy for lower bile duct cancer. At the beginning of oral intake after surgery, the discharge from the drain changed from a serous fluid to a milky one and increased in volume. Because the triglyceride concentration was 2700 mg/dl of the discharge, we diagnosed the fluid accumulation as chylous ascites. In spite of dietary restriction of fat and intravenous hyperalimentation, the discharge did not decrease. Then a reoperation was performed. In that operation, a stream of milky fluid was found, coming from the stump of the intestinal lymphatic trunk of the radix mesenterii. A transfixing suture was used to close it. Because chylous ascites due to operative injury is uncommon, its management is not yet established. As in this case, surgical treatment should be performed without persistence of conservative treatment when a milky discharge from the drain increases immediately after the operation.

Key words
postoperative chylous ascites, bile duct cancer, pylorus preserving pancreatoduodenectomy

Reprint requests
Takashi Matsushiro Department of Surgery, Tohoku Rosai Hospital
4-3-21, Dainohara, Aobaku, Sendai, 981 JAPAN

Accepted
June 12, 1996

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