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Ann Thorac Surg 2021 Jun 8. Epub 2021 Jun 8.

Division of Plastic Surgery, Department of Surgery, University of Pennsylvania. Electronic address:

Noonan Syndrome is a disorder characterized by central and peripheral lymphatic conducting anomalies, leading to chylothorax, chylous ascites, and metabolic derangement. Novel imaging modalities including dynamic contrast magnetic resonance lymphangiography (DCMRL) and intranodal lymphangiography have allowed for increased visualization of lymphatic pathology. We describe the first study of a 61-year-old male with Noonan syndrome who developed severe pulmonary insufficiency and chylothoraces. Read More

J Visc Surg 2021 May 19. Epub 2021 May 19.

Department of general, visceral, and transplantation surgery, Ludwig-Maximilians University, Marchioninistraße 15, 81377 Munich, Germany. Electronic address:

Purpose: With increasing soft tissue clearance in pancreatic cancer surgery, postoperative chyle leak (CL) has become a more commonly observed complication. Recently, a new consensus definition was established by the International study group of pancreatic surgery (ISGPS). The aim of the present analysis was to evaluate risk factors and treatment options of patients with CL after pancreatic surgery. Read More

Chest 2021 Apr 6;159(4):e189-e191. Epub 2021 Apr 6.

Department of Pediatrics, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.

A trisomy 21 neonate presented with congenital chylous pleural effusion and ascites that was refractory to conventional pharmacotherapy. Midodrine, an oral alpha-1-adrenoreceptor agonist, achieved remission of chylous effusion without any adverse effects. To the best of our knowledge, this is the first neonatal case of successful management of congenital chylous pleural effusion and ascites with midodrine. Read More

J Vasc Surg Cases Innov Tech 2021 Jun 26;7(2):235-238. Epub 2021 Feb 26.

Angiopediatria Foundation, Buenos Aires, Argentina.

We present the case of a 45-year-old man who had presented with ubiquitous chylous reflux that manifested as a bilateral inguinal chylous cutaneous fistula and a voluminous right cervical chylous cyst. He had difficulty breathing owing to compression of the airway. Anastomosis of the chylous cyst wall with the external jugular vein was performed using a valvular vein segment to prevent blood reflux. Read More

Intern Med 2021 May 14. Epub 2021 May 14.

Department of Gastroenterology, Tokyo-Kita Medical Center, Japan.

A 79-year-old man with underlying alcoholic liver cirrhosis presented with complaints of a fever, abdominal pain, and difficulty walking. A diagnostic work-up revealed liver atrophy and chylous ascites, and spontaneous bacterial peritonitis (SBP) was diagnosed based on the cell and neutrophil counts. The Burkholderia cepacia complex (Bcc) was detected on blood and ascitic fluid cultures. Read More

Surg Endosc 2021 May 14. Epub 2021 May 14.

Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 122, Indianapolis, IN, 46202, USA.

Background: Chylous ascites is often reported in cases with lymphatic obstruction or after lymphatic injuries such as intraabdominal malignancies or lymphadenectomies. However, chylous ascites is also frequently encountered in operations for internal hernias. We sought to characterize the frequency and conditions when chylous ascites is encountered in general surgery patients. Read More

J Surg Case Rep 2021 May 8;2021(5):rjab176. Epub 2021 May 8.

Department of General Surgery, Caboolture Hospital, Caboolture, Queensland, Australia.

Chylous ascites (CA) results in a thick white ascitic fluid, akin to milk. It is most commonly caused by malignancy and cirrhosis in adults. Here we present only the second reported case of primary small bowel volvulus resulting in CA in the virgin abdomen. Read More

Gan To Kagaku Ryoho 2021 Apr;48(4):563-565

Dept. of Surgery, Tokyo Metropolitan Otsuka Hospital.

A female in her 70s was diagnosed as sigmoid colon cancer. Laparoscopic sigmoidectomy was performed. Chylous ascites was observed after starting oral intake. Read More

J Pediatr Gastroenterol Nutr 2021 Mar 15. Epub 2021 Mar 15.

*INSERM (National Institute of Health and Medical Research) U1016, Université Paris-Descartes, Institut Cochin, Paris, France †Pediatric Surgery Unit, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France. ‡Pediatric Gastroenterology-Hepatology-Nutrition Unit, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France. §Pediatric Intensive Care Unit, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France. ||Department of Pediatric Surgery, Hôpital Universitaire de Tours, Tours, France ¶Université Paris Descartes, 75015 Paris, France.

Intractable ascites is a rare condition in children mainly caused by cirrhosis or lymphatic disorders. Internal drainage may be considered as rescue therapy. In our department, 4 patients aged from 2 months to 15 years old underwent a peritoneovenous shunt (PVS) placement between 2010 and 2020. Read More

Cureus 2021 Mar 22;13(3):e14044. Epub 2021 Mar 22.

Nephrology, University of California Los Angeles, Los Angeles, USA.

We describe the case of a 62-year-old female who presented with gradually progressing abdominal distension and dyspnea. Computed tomography (CT) chest and abdomen revealed large bilateral pleural effusions with large ascites, a mid-abdominal mass, and peritoneal carcinomatosis. Pleural and peritoneal tap revealed chylous fluid, and the biopsy findings from abdominal mass were consistent with follicular lymphoma. Read More

J Minim Access Surg 2021 Apr 8. Epub 2021 Apr 8.

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.

Renal lymphangiectasia characterised by either unilocular or multilocular cystic lesion in and around the kidney is an uncommon condition. Presentation of these lesions is quite varied, which along with its uncommon occurrence adds to the challenges in the management of this condition. Most of these cases are managed conservatively and very rarely need any intervention. Read More

Microsurgery 2021 May 17;41(4):376-383. Epub 2021 Apr 17.

Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.

Chylous ascites is the leakage of lipid-rich lymph into the peritoneal cavity usually due to disruption of lymphatics or increased peritoneal lymphatic pressure. Various surgical options have been proposed to treat chylous ascites but most have shown suboptimal outcomes. The gastroepiploic vascularized lymph node (GE-VLN) flap has been described previously for the treatment of lymphedema. Read More

Ann Ital Chir 2021 Apr 12;10. Epub 2021 Apr 12.

We report an uncommon case of idiopathic acute chylous peritonitis mimicking an acute appendicitis in a 30-year-old female patient with a 2-day history of abdominal pain, nausea and vomiting. Chylous ascites is a rare form of ascites characterized by the presence of a milky fluid rich in triglycerides. It occurs as a result of a damage to the lymphatic system due to trauma or other benign and malignant pathologies. Read More

Gland Surg 2021 Mar;10(3):1260-1267

Department of Radiology, Seoul National University Hospital, Seoul, Korea.

Post-operative lymphatic leakage is a common complication of a radical gynecologic surgery involving aggressive lymph node dissection. Its manifestation varies from asymptomatic lymphoceles to life-threatening chylous ascites. In the past, nuclear medicine lymphoscintigraphy was the sole imaging modality for the confirmation of the leakage, of which application is limited due to its poor spatial resolution. Read More

Microsurgery 2021 Apr 6. Epub 2021 Apr 6.

College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Postoperative chylous ascites is a rare but highly morbid complication following thoracic or abdominal surgeries. Treatment options vary according to different clinical scenarios and facility equipment, but there is no standard guideline. We report a case of 46-year-old patient with chylous ascites after left laparoscopic adrenalectomy for metastatic lung cancer. Read More

World J Hepatol 2021 Mar;13(3):300-314

Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna 801507, Bihar, India.

The lymphatic system plays a very important role in body fluid homeostasis, adaptive immunity, and the transportation of lipid and waste products. In patients with liver cirrhosis, capillary filtration markedly increases, primarily due to a rise in hydrostatic pressure, leading to enhanced production of lymph. Initially, lymphatic vasculature expansion helps to prevent fluid from accumulating by returning it back to the systemic circulation. Read More

Microsurgery 2021 Apr 3. Epub 2021 Apr 3.

Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan.

Background: Lymphatic diseases due to lymph vessel injuries in the pelvis and groin require immediate clinical attention when conventional treatments fail. We aimed to clarify the effectiveness of and indications for lymphaticovenular anastomosis (LVA) to treat these lymphatic diseases.

Methods: We retrospectively evaluated six patients who underwent LVA for lymphatic diseases due to lymph vessel injuries in the pelvis and groin. Read More

Int Cancer Conf J 2021 Apr 23;10(2):149-153. Epub 2021 Jan 23.

Department of Surgery, Tokyo Women's Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo, 116-8567 Japan.

A 61-year-old woman underwent laparoscopy-assisted distal gastrectomy (LADG) with extragastric lymph node dissection (D2). Two months later, she was readmitted to hospital to be treated for chylous ascites. Oral intake was discontinued and total parenteral nutrition started, but increasing body weight and decreasing serum albumin concentration was not controllable. Read More

Gut Liver 2021 Mar 31. Epub 2021 Mar 31.

Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Background/aims: The endoscopic step-up approach is accepted as the preferred treatment for complicated or symptomatic walled-off necrosis (WON). Direct endoscopic necrosectomy (DEN) is an effective therapeutic option, but few reports describe long-term follow-up in this patient population. Thus, we aim to assess the long-term outcomes of DEN following severe necrotizing pancreatitis. Read More

Int J Surg Case Rep 2021 Apr 17;81:105790. Epub 2021 Mar 17.

St John of God Hospital, Midland. 1 Clayton Street, Midland, 6056 Western Australia, Australia. Electronic address:

Introduction And Importance: Chylous ascites (CA) is an extremely rare presentation in pregnancy and poses a diagnostic challenge in clinical practice. There have only been a few case reports of CA in pregnancy with the majority of cases found incidentally at the time of caesarean section or in the context of pancreatitis.

Case Presentation: A 36-year-old female who was 13 weeks pregnant had clinically presented right iliac fossa pain with peritonitis and had signs of sepsis. Read More

J Surg Case Rep 2021 Mar 13;2021(3):rjab029. Epub 2021 Mar 13.

Kansas City University, Kansas City, MO 64106, USA.

Chylous ascites (CA) is the leakage of triglyceride-rich fluid into the peritoneal cavity. This most commonly occurs due to trauma of the lymphatic system. Recently, lymphangiography with lipiodol have been used with promising results in managing refractory postoperative CA. Read More

Hepatology 2021 Mar 19. Epub 2021 Mar 19.

Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN.

Cardiovasc Intervent Radiol 2021 Jul 15;44(7):1127-1130. Epub 2021 Mar 15.

Department of Diagnostic Radiology, Osaki Citizen Hospital, 3-8-1 Honami, Furukawa, Osaki-shi, Miyagi, 9896183, Japan.

Hepatic lymphorrhea is a leakage from the liver's lymphatic ducts into the abdominal cavity and an extremely rare complication associated with injury of the hepatoduodenal ligament, which can lead to refractory ascites. Hepatic lymphorrhea is constituted by non-chylous ascites and can be visualized by transhepatic lymphangiography instead of pedal or intranodal lymphangiography. To date, only a few successfully treated cases using interventional procedures have been reported. Read More

ACG Case Rep J 2021 Mar 3;8(3):e00517. Epub 2021 Mar 3.

Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.

A 35-year-old woman presented to the hospital with a 4-week history of large-volume chylous ascites refractory to paracentesis and new-onset dyspnea. Thoracic computed tomography revealed diffuse pulmonary cystic lesions with pleural effusions, and abdominal computed tomography showed ascites with large bilateral retroperitoneal masses displaying positron emission tomography avidity. Biopsy of the masses demonstrated lymphatic invasion by a perivascular epithelioid cell neoplasm, a smooth muscle tumor. Read More

BMJ Case Rep 2021 Mar 5;14(3). Epub 2021 Mar 5.

Gastroenterology and Hepatology, North Bristol NHS Trust, Bristol, UK.

We describe an interesting case of a 77-year-old man presenting with refractory chylous ascites of unknown aetiology. After extensive diagnostic workup, unifying diagnosis of an intriguing condition of yellow nail syndrome was reached. This case is unusual as it describes a rare cause of chylous ascites in this age group. Read More

Diagnostics (Basel) 2021 Feb 17;11(2). Epub 2021 Feb 17.

Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8640, Japan.

The greater omentum is an apron-like peritoneal mesothelial sheet that was described by ultrasound as a floating fluid-filled viscus in ascites during the fetal period. To examine the association between the etiology of fetal ascites and ultrasound findings of the greater omentum, a retrospective study was conducted. Ultrasound findings of fetal omentum were defined as follows: (1) a cyst-like shape with a thin membrane observed as wavy in the ascites, (2) beside the stomach and below the liver, and (3) no blood flow noted on color Doppler. Read More

CVIR Endovasc 2021 Mar 3;4(1):26. Epub 2021 Mar 3.

Department of Radiology, Aventura Hospital & Medical Center, 20900 Biscayne Blvd, Aventura, FL, 33180, USA.

Background: Sinistral portal hypertension results from obstruction or stenosis of the splenic vein and is characterized by normal portal vein pressures and liver function tests. Gastrointestinal bleeding is the most common presentation and indication for treatment. Although sinistral portal hypertension-related chylous ascites is rare, several cases have described successful treatment with portal venous, rather than splenic venous, recanalization. Read More

Transl Pediatr 2021 Jan;10(1):188-193

Department of Pediatric Critical Medicine, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.

Chylous ascites refers to the accumulation of lymphatic fluid in the peritoneal cavity. The causes of chylous ascites are various, and commonly include traumatic injury and obstruction, which disrupt the lymphatic system. In addition, cardiothoracic surgery may injure the thoracic duct and lead to chylothorax. Read More

Nucl Med Rev Cent East Eur 2021 ;24(1):29-30

Nuclear Medicine Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic Of.

We reported 99m-Tc phytate accumulation in the pyelocalyceal system of the kidney in the lymphoscintigraphic images of a 3.5 months-old male infant with chylous ascites, which was mistaken with the site of lymph leakage. SPECT/CT localized activity in the para-aortic region to the renal pelvis and on delayed images, this was disappeared. Read More

Am Surg 2021 Feb 8:3134821991986. Epub 2021 Feb 8.

Department of General Surgery, 27121Townsville University Hospital, Townsville, Queensland, Australia.