Chylous Ascites Post Laparoscopic Sleeve Gastrectomy: Video Case Report of a Rare Complication
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MULTIMEDIA ARTICLE
Chylous Ascites Post Laparoscopic Sleeve Gastrectomy: Video Case Report of a Rare Complication Alwahhaj Khogeer 1 & Aly Elbahrawy 1,2 & Ali Almontashery 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract We report a 38-year-old morbidly obese female patient, who presented 10 days post sleeve gastrectomy with chylous ascites. A lymphangiogram showed free leakage from a small tributary of the cisterna chyli. Conservative measures failed to control the leak. The patient was taken for surgery. Laparoscopic exploration with intralipid injection through an orogastric tube revealed the leaking area near the hiatal surface posterior to the stomach and it was ligated with non-absorbable sutures and wrapped with a thrombin patch. The patient was discharged home in a good condition. Patient was followed up in the clinic after 2 weeks, 6 weeks, and 3 months with no complaint. Keywords Bariatric surgery complications . Sleeve gastrectomy . Chylous ascites
Introduction Over the past 20 years, there has been a drastic increase in bariatric procedures [1]. Consequently, rare complications have begun to emerge [2, 3]. We report a case of chylous ascites post sleeve gastrectomy with its management.
Case Report A 38-year-old morbidly obese female patient (BMI 48 kg/m2), presented to our tertiary care center 10 days post laparoscopic sleeve gastrectomy performed at a private hospital, complaining of abdominal pain and distention. Her examination revealed normal vitals, distended abdomen, mild diffuse tenderness, and Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04548-7) contains supplementary material, which is available to authorized users. * Aly Elbahrawy [email protected] 1
Department of Specialized Surgery, King Abdullah Medical City, Makkah, Saudi Arabia
2
Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt
positive shifting dullness. Her labs were within normal. An abdominal CT scan with IV and oral contrast revealed multiple large fluid collections with no evidence of leakage. Percutaneous drainage brought 4 L of milky fluid. Triglyceride (TG) level was sent from the drain fluid and was 278 mg/dL. As ascitic TG level higher than 110 mg/dL is defined as chylous ascites [4], a diagnosis was established. A lymphangiogram was done and showed free leakage from a small tributary of the cisterna chyli into the abdominal cavity. The patient was started on conservative management by keeping her NPO, putting her on total parenteral nutrition (TPN) without lipid emulsions and octreotide injections. A trial of sclerotherapy by interventional radiology to seal the leakage was attempted but failed. Our patient was offered surgery at that stage, but she refused. The same conservative measures were continued for another 4 weeks. After starting oral diet, the drainage output increased to 400– 500 mL/day, and the drain TG level was high. The patient was taken for surgery. Laparosco
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