Chylous Ascites after Extended Lymphnode Dissection for Gastric Cancer

Masato Endo, Keiichi Maruyama, Taira Kinoshita, Mitsuru Sasako

Gastric Surgery Division, National Cander Center Central Hospital

A patient with severe chylous ascites was experienced after extended lymphnode dissection for gastric cancer. The 5l-year-old woman received a distal gastrectomy, and had continuous fluid retention in the abdominal cavity post-operatively. The puncture fluid was typical chylous ascites: milky colored fluid containing fat globules confirmed by Sudan III staining. She was treated conservatively until the 62nd postoperative day by IVH, diuretics and reinfusion of concentrated ascites. The first diagnosis was chylous abdomen caused by injury of the lymphatic vessels during the operation, but it was corrected by the second laparotomy. No leakage was observed from the major lymphatic vessels by milk drinking test or intraoperative lymphography. Severe fibrosis was found around the celiac and superior mesenteric arteries due to the complete lymphnode dissection. Severe edema was observed at the small intestine and mesenterium, and serous fluid oozed from the entire surface of the mesenterium. From these findings, we considered that the chylous ascites was cased by complete obsturaction of the lymphotic channels around the celiac and superior mesenteric arteries. No surgical treatment was indicated in this condition. The same treatment was continued after exploratory laparotomy, but the chylous ascites improved gradually, and the patient left the hospital on the 90th day after gastrectomy.

Key words
postoperative chylous ascites, gastric cancer, lymphnode dissection

Reprint requests
Masato Endo Second Department of Surgery, Chiba University
1-8-1 Inohana, Chuou-ku, Chiba, 260 JAPAN

Accepted
December 8, 1993

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