1/13. Postmenarchal development of chylous ascites in acrocephalosyndactyly with congenital lymphatic dysplasia.BACKGROUND: Acrocephalosyndactyly is a syndrome characterized by congenital malformation of the skull with craniosynostosis, midface hypoplasia, and symmetrical webbed fusion of the fingers and toes. We describe a possible pathophysiologic mechanism for chylous ascites that developed several months after menarche in a woman with acrocephalosyndactyly and congenital lymphatic dysplasia. CASE: A 25-year-old nulligravid woman with acrocephalosyndactyly, at 18 months after menarche, developed persistent abdominal distension at age 18 years. laparoscopy at age 25 years revealed chylous ascites with marked chronic peritoneal inflammation, and lymphatic dysplasia with lymphocysts. With hormone manipulation, the chylous ascites fluctuated. CONCLUSION: After menarche in a woman with acrocephalosyndactyly, ovarian steroid hormones might have increased lymph production and hydrostatic pressure, causing rupture of congenitally dysplastic lymph vessels resulting in chylous ascites.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/13. Non-traumatic chylous effusion in the thorax and abdomen.A female of 31 with chyloascites and bilateral chylothorax is presented. The thoracic duct was obstructed below the diaphragm. The lymph vessels in the left iliac and para-aortic areas were enlarged and there were lymphocysts. When the lymph loss was greatest the patient was in a state of grave malnutrition with marked hypoalbuminaemia and an absolute and relative lymphocytopenia in the blood. "Malignant" cells were demonstrated in the chylous fluid, but no malignancy could be found at laparotomy. It is possible that the cells were confused with immature lymphocytes. The lymphatic cysts were excised and the lymph vessels ligated. Decortication of the right lung was performed. The patient recovered. The follow up time has been over four years.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
3/13. Postoperative chylous ascites: a rare complication of laparoscopic Nissen fundoplication.The accumulation of chylous fluid in the abdominal cavity is an infrequent, yet alarming, complication in abdominal surgery. Laparoscopic fundoplication has assumed a central role in the surgical treatment of gastroesophageal reflux disease and is significantly altering the balance of therapy toward more common and earlier surgical intervention. We report the case of a 67-year-old woman with gastroesophageal reflux disease and intense esophagitis who underwent a laparoscopic Nissen fundoplication in February 2000. The procedure was performed without apparent complications. Twenty days later, the patient complained of abdominal pain and distension. ultrasonography showed ascites, whereas endoscopic and radiological exploration of the fundoplication demonstrated no abnormalities. A paracentesis was performed, which showed a milky fluid with high concentrations of triglycerides (1024 ng/dL) and cholesterol (241 ng/dL). The patient was treated successfully with total parenteral nutrition for 3 weeks, followed by a low-fat diet. To our knowledge, this is the third reported case of chylous ascites after a Nissen fundoplication and the second case after laparoscopic fundoplication. The development of chylous ascites seems to be related to the injury of lymphatic vessels, including the thoracic duct, during the retroesophageal window dissection. The careful dissection and judicious use of diathermy is proposed to prevent this rare complication.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/13. chylous ascites following liver resection--case report.chylous ascites is an intraperitoneal collection of fluid that appears milky because of the presence of unusual amounts of fat. It is a result of interference, interruption, or obstruction of lymph flow through chyle-transporting vessels, and remains rare as a complication of surgical intervention. liver resection has been infrequently reported as a cause of chylous ascites. We report a case of chylous ascites developing after laparotomy and right lobe liver resection, which was diagnosed early and managed conservatively with minimal morbidity. The key lies in awareness of the condition, early diagnosis, and aggressive management with nutritional support.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/13. Unusual findings during abdominal placement of a ventriculoperitoneal shunt: report of three cases.The authors present three cases of infants born with myelodysplasia. Each infant underwent closure of a myelomeningocele and within 2 to 4 days placement of a ventriculoperitoneal (VP) shunt. In each case, on opening the peritoneal cavity, the authors observed egress of a dark or creamy dark fluid. None of the patients had a history of abdominal birth trauma. The decision was made to continue the procedures and send samples of the unusual fluids to the laboratory for culture and analysis. The cultures proved to be nondiagnostic and the characteristics of the fluid samples were most consistent with those of blood-tinged chyle. The authors hypothesize that, occasionally, the mechanical tautness that is created with repair of myelomeningoceles is sufficient to rupture small lymphatic vessels and accompanying blood vessels of the abdomen. An alternative hypothesis is that abdominal compression due to closure of the myelomeningocele may temporarily compress the liver, leading to raised intraportal pressures and resulting in weeping of chyle from the gastrointestinal tract. This abnormal fluid accumulation did not lead to chronic ascites, VP shunt infection, or dysfunction at long-term follow-up examination and abdominal visceral function has not been an issue.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
6/13. chylous ascites after laparoscopic donor nephrectomy.Laparoscopic living-donor nephrectomy has decreased the disincentives to live renal donation with a risk of complications similar to that of open donor nephrectomy. We report a patient who developed chylous ascites after an otherwise-uneventful laparoscopic donor nephrectomy. On medline search, we could find only two other cases with similar complications. This condition has the potential to cause significant morbidity in the donor, which may reduce the advantages of the minimally invasive approach. We suggest that meticulous dissection of the renal hilum and clipping of lymphatic tissue around the renal vessels could prevent this untoward complication.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/13. Primary disorders of the lymphatic vessels--a unified concept.Congenital defects of lymphatics constitute a spectrum of disorders that may manifest with a variety of clinical presentations including lymphedema, chylous effusions, lymphangiomatous malformations with cystic masses and localized gigantism, and intestinal lymphangiectasia with malabsorption. These entities constitute a relatively rare group of disorders, the origin of which remains somewhat controversial, but in some it appears to be due to early lymphatic obstruction. Five cases are described, which demonstrate the anatomical pathology of these entities. A classification and description of the defects is also presented. An attempt is made to present a unified theory of origin for this seemingly diverse group of diseases. While these entities may be challenging from a diagnostic and therapeutic standpoint, a wide variety of imaging modalities, which includes lymphography, computed tomography scanning, and ultrasound, may be used to diagnose the extent and internal structural characteristics of the abnormalities.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
8/13. lymphangioleiomyomatosis with chylous ascites.A 41-year-old Malay housewife presented with recurrent chylous ascites and progressive cachexia over 17 years. A diagnosis of lymphangioleiomyomatosis (LAM) was established by laparotomy where biopsy of the liver, peritoneum and adhesions from previous surgery showed smooth muscle proliferation in the blood vessels and lymphatics. Clinically and radiologically, there was no evidence of pulmonary involvement. She was treated with dietary fat restriction and medium-chain triglycerides. This is the first case of LAM reported in malaysia.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/13. Successful treatment of postretroperitoneal lymph node dissection in massive chylous ascites.A rare complication of retroperitoneal surgery is damage to lymphatic vessels, leak of chyle and the development of chylous ascites. This complication can be life threatening and has a relatively high mortality rate. We describe a 38-year-old patient with a massive chylous ascites after extensive retroperitoneal lymph node dissection of metastatic nonseminomatous germ cell testicular tumor. The patient was treated surgically and with fat-free diet, medium chain triglycerides and diuretics resulting in complete resolution of the ascites.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/13. thoracic duct-cutaneous fistula in a patient with cirrhosis of the liver: successful treatment with a transjugular intrahepatic portosystemic shunt.patients with cirrhosis of the liver have increased hepatic and gastrointestinal lymph flow that may contribute to the formation of ascites and pleural effusions. Increased lymph flow, which is due to postsinusoidal portal hypertension, causes a high rate of flow through the thoracic duct. Because of the high flow rates, disrupted lymphatic vessels in patients with cirrhosis of the liver may fail to close, a situation that results in chylous ascites, pleural effusions, or chylous fistulas. Chylous fistulas deplete proteins, fluid, and lymphocytes and thus lead to volume depletion and coagulopathy. Herein we describe an unusual case in which a high-output traumatic thoracic duct-cutaneous fistula developed in a patient with cirrhosis and led to volume depletion and coagulopathy. Correction of the portal hypertension with placement of a transjugular intrahepatic portosystemic shunt led to closure of the fistula and normalization of accompanying metabolic abnormalities.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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