Chyloperitoneum Due to Small Bowel Obstruction Following Laparoscopic Roux-en-Y Gastric Bypass: a Case Report and Review
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LETTER TO THE EDITOR
Chyloperitoneum Due to Small Bowel Obstruction Following Laparoscopic Roux-en-Y Gastric Bypass: a Case Report and Review of Literature Khosrow Najjari 1 & Amirali Haji Ghafouri 1 & Hossein Zabihi Mahmoudabadi 1 Received: 20 October 2020 / Revised: 7 November 2020 / Accepted: 11 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Acute chyloperitoneum is a rare condition, which was firstly reported by Renner in 1910 [1]. It is defined as the accumulation of a creamy, colorless, and odorless lymphoid fluid with triglyceride (TG) levels greater than 110 mg per cc (which equals 2 to 8 times the concentration of triglycerides in the plasma) within the abdominal space/peritoneum. Primary chyloperitoneum rarely occurs in adults [2], and the three main causes of chyloperitoneum in adults include: 1. Fluid leakage from the walls of dilated vessels due to obstruction of the lymphatic pathway by a mass or tumor or leakage of lymphatic fluid from ruptured lymphatic vessels because of local invasion; 2. Formation of a fistula between lymphatic ducts, peritoneum, or mesentery because of adhesions, trauma, or surgery; 3. Leakage from large ducts of the retroperitoneal lymphatic system, which usually occurs during childhood and is mostly caused by congenital disorders like lymphangiectasia and thoracic duct obstruction [3]. Overall, most of the reported cases of chyloperitoneum have been associated with malignancy. However, there are reports of chyloperitoneum after vascular surgeries or cancer-related surgeries, which is due to traumatic damage to the lymphatic system.
* Hossein Zabihi Mahmoudabadi [email protected] Khosrow Najjari [email protected] Amirali Haji Ghafouri [email protected] 1
Department of Surgery, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Few cases of chyloperitoneum or chylous ascites in association with acute obstruction, particularly obstruction following bariatric surgery, are reported. Here, we report a case of chyloperitoneum due to intestinal obstruction as a result of internal hernia following bariatric Roux-en-Y surgery. A 47-year-old woman presented to the emergency room with severe abdominal pain from 2 h before admission. The pain was mostly located in the epigastric region, was colic, radiated to the back and flanks, and became more severe when lying down. She also complained of nausea and anorexia. The last bowel movement was a day ago. She said she had no signs of dyspepsia, heartburn, or any symptoms of gastrointestinal bleeding. The last menstrual period (LMP) of the patient was 3 weeks ago, and she had no vaginal discharge. She also had a history of RouX-en-Y laparoscopic gastric bypass 2 years ago due to obesity and mentioned 32 kg weight loss (equal to 30%) during the past 2 years. Vital signs recorded for the patient at entrance were as follows: pulse rate (PR), 80; temperature (T), 36.6; respiratory rate (RR), 18; and blood pressure (BP), 120/80. The patient was agitated on
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