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Diagn Cytopathol 2020 Jun 27. Epub 2020 Jun 27.

Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Ascites due to Mycobacterium avium intracellulare (MAI) infection is extremely rare and associated with a poor outcome. The cytomorphology of this condition has not been previously reported. We present a unique case of a 45-year-old woman with iatrogenic immunodeficiency who developed MAI-associated chylous ascites. Read More

J Coll Physicians Surg Pak 2020 May;30(5):557-558

Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.

Null. Read More

J Robot Surg 2020 Jun 22. Epub 2020 Jun 22.

The James Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

The objectives were to evaluate the safety and oncologic efficacy of primary robotic retroperitoneal lymph node (R-RPLND) dissection for testicular germ cell tumors. A retrospective analysis was performed on all primary R-RPLND cases performed by a single surgeon, who performs both open and R-RPLND at a high-volume academic institution, between August 2013 and August 2019. Data on patient demographics, operative techniques, perioperative outcomes, and tumor characteristics were obtained. Read More

Ann Transplant 2020 Jun 16;25:e922602. Epub 2020 Jun 16.

Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.

BACKGROUND Minimally invasive surgery (MIS) has rapidly advanced, but its use in transplant patients has lagged. We share our experience of MIS for patients after kidney and liver transplantation and compare our results with similar studies in the literature. MATERIAL AND METHODS This study included 14 MIS (12 laparoscopic, 2 transvaginal) procedures for 13 transplant cases (6 liver and 7 kidney) done from May 2006 to May 2018. Read More

Zhonghua Gan Zang Bing Za Zhi 2020 May;28(5):372-376

Department of Gastroenterology and Hepatology, Beijing You'an Hospital Affiliated to Capital Medical University, Beijing 100069, China.

The rare complications of cirrhosis, such as chylous ascites, hepatic hydrothorax, spontaneous bacterial peritonitis, cirrhotic cardiomyopathy, portopulmonary hypertension, cirrhotic nervous system damage, etc., have not yet been fully understood and/or promptly and effectively diagnosed and treated by clinicians. Therefore, this article aims to introduce the above-mentioned rare complications, clinical features, treatment and prognosis of liver cirrhosis in an attempt to improve the clinicians' understanding and level of diagnosis and treatment. Read More

Pediatr Int 2020 Jun 11. Epub 2020 Jun 11.

Department of Pediatirc Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama City, Wakayama, Japan.

Can Assoc Radiol J 2020 Jun 8:846537120929429. Epub 2020 Jun 8.

Division of Interventional Radiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada.

Purpose: Management of chylous ascites is poorly understood with no management guidelines. We retrospectively reviewed patients treated for chylous ascites at our institution to evaluate efficacy and safety of lipiodol lymphangiography and embolization.

Materials And Methods: Seven patients underwent percutaneous interventional management of chylous ascites (average age 52. Read More

J Vasc Surg Venous Lymphat Disord 2020 Jun 4. Epub 2020 Jun 4.

Department of Plastic and Reconstructive Surgery, Mie University Hospital, Mie, Japan.

Large abdominal lymphatic malformations are rare and may occasionally cause life-threatening illness especially when they involve the central lymphatic system, lumbar trunks, cisterna chyli, thoracic duct and their major tributaries forming complex lymphatic anomalies. These LM are often accompanied by chylous leak in various locations and treatment remains challenging. We report a case of large abdominal lymphatic malformation with chylous ascites, protein-losing enteropathy, vaginal chylous leak and lower limb lymphedema successfully treated with microsurgical intra-abdominal lymphovenous anastomosis and discuss the technical details of the procedure. Read More

SAGE Open Med Case Rep 2020 6;8:2050313X20921332. Epub 2020 May 6.

Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA.

Lymphangioleiomyomatosis is a rare systemic disorder of unknown etiology that affects young women almost exclusively. Chylous effusions are known to be associated with lymphangioleiomyomatosis and may be difficult to treat. We present the case of a 37-year-old female who received bilateral lung transplantation for lymphangioleiomyomatosis complicated by refractory chylothorax and chylous ascites, ultimately controlled through repeated, open surgical procedures and percutaneous lymphatic embolization interventions. Read More

Radiol Case Rep 2020 Jul 19;15(7):1044-1049. Epub 2020 May 19.

Interventional Radiology Section, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195, USA.

Chylous ascites is a rare, but highly morbid complication of oncologic resection, often associated with retroperitoneal lymphadenectomy. Conservative measures with total parenteral nutrition or lipid-reduced formulas constitute the initial mainstay therapy, but not without risks and failures. This report describes 2 endolymphatic treatment strategies for iatrogenic chylous ascites following neuroblastoma resection. Read More

Transplant Proc 2020 May 21. Epub 2020 May 21.

Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address:

Background: Laparoscopic donor nephrectomy (LDN) is considered the gold standard for live donor nephrectomies owing to lesser pain, shorter hospitalization, and earlier return to normal activities, yet it remains a technically challenging surgery. Repetition of a highly skilled task such as LDN should lead to improved performance reflected in shorter surgery times and a decrease in adverse events.

Methods: The records of over 2524 LDNs from February 2004 to June 2019 were evaluated for duration of surgery (from incision time to clamping of the renal artery) and occurrence of complications. Read More

Med Clin (Barc) 2020 May 20. Epub 2020 May 20.

Servicio de Urgencias, Hospital Universitario Virgen de las Nieves, Granada, España.

Ann Vasc Surg 2020 May 19. Epub 2020 May 19.

Department of Radiology and Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea. Electronic address:

Background: Lymphatic interventions have recently been increasingly used for treating lymphatic leak of the abdomen and pelvis. This retrospective case study series and systematic review evaluated the efficacy and safety of lymphatic interventions for the treatment of postoperative lymphatic leak of the abdomen and pelvis.

Methods: A total of 15 consecutive patients with postoperative lymphatic leak of the abdomen and pelvis treated with lymphatic interventions (i. Read More

Case Rep Gastroenterol 2020 Jan-Apr;14(1):197-205. Epub 2020 Apr 21.

Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan.

We report the case of a 55-year-old man with a surgical history of distal gastrectomy with Roux-en-Y reconstruction performed 3 years prior to the present episode. During the follow-up, a newly developed, rapidly growing intraabdominal mass was detected in the mesentery of the small intestine. Although the patient had been asymptomatic, surgical resection was planned with the suspicion of malignancy, especially lymph node recurrence of the gastric cancer, owing to its rapid growth. Read More

BMC Surg 2020 May 6;20(1):91. Epub 2020 May 6.

Department of Surgery A, Galilee Medical Center, Nahariya, Israel.

Background: One anastomosis gastric bypass- minigastric bypass (OAGB-MGB) is an emerging bariatric surgery that is being endorsed by surgeons worldwide. Internal herniation is a rare and dreaded complication after malabsorptive bariatric procedures, which necessitates early diagnosis and intervention.

Case Presentation: We describe a 29-year-old male with chylous ascites caused by an internal hernia 8 months following laparoscopic one anastomosis gastric bypass. Read More

J Urol 2020 May 4:101097JU0000000000001121. Epub 2020 May 4.

Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.

Purpose: To investigate the efficacy and analyze the complication risk factors of peritoneovenous shunt (PVS) in treating refractory chylous ascites (CA) following retroperitoneal lymph node dissection (RPLND) in patients with urologic malignancies.

Materials And Methods: From April 2001 to March 2019, all patients with refractory CA after RPLND treated with PVS were reviewed. Demographic characteristics, technical success, efficacy, patency period and complications were studied. Read More

Urol Case Rep 2020 Sep 16;32:101207. Epub 2020 Apr 16.

Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.

Chylous ascites (CA) is a known complication of retroperitoneal surgery. We are reporting the case of a 65-year-old male who underwent a robotic assisted laparoscopic (RAL) partial nephrectomy for a renal mass and subsequently developed CA. He was successfully treated with a low-fat diet and maintenance of a surgical drain. Read More

Klin Onkol 2020 ;33(2):145-149

Background: Chylous ascites or chyloperitoneum can be caused by peroperative injury of the lymphatic pathways; the lymph is accumulated in the abdominal cavity. The incidence of chylous ascites varies according to the type of surgery and the extent of the lymphadenectomy. The first choice of treatment is a conservative procedure - total parenteral nutrition or a strict low-fat diet. Read More

J Physiol 2020 Jun 10;598(12):2297-2310. Epub 2020 May 10.

Department of Medical Pharmacology and Physiology, School of Medicine, University of Missouri, Columbia, MO, USA.

Key Points: Lymphatic valve defects are one of the major causes of lymph transport dysfunction; however, there are no accessible methods for quantitatively assessing valve function. This report describes a novel technique for quantifying lymphatic valve back-leak. Postnatal endothelial-specific deletion of connexin 43 (Cx43) in connexin 37 null (Cx37 ) mice results in rapid regression of valve leaflets and severe valve dysfunction. Read More

CVIR Endovasc 2020 Apr 6;3(1):20. Epub 2020 Apr 6.

Department of Radiology, Bethesda-Hospital Duisburg, Heerstr. 219, 47053, Duisburg, Germany.

Background: Iatrogenic injury of the thoracic duct with clinical significant chyloperitoneum is a rare complication of abdominal surgery. Chyloperitoneum following laparoscopic Nissen fundoplication has been described in a few cases only. Most interventionists use the antegrade transperitoneal approach for thoracic duct embolization. Read More

Rofo 2020 Mar 26. Epub 2020 Mar 26.

Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart, Germany.

Background:  Postoperative lymphatic leakage (PLL) is usually managed by conservative and/or surgical treatments but these procedures can be challenging to perform and potentially clinically ineffective. Therefore, conventional lymphangiography (CL) has emerged as an important alternative. The aim of this review is to present the available outcome data on CL in the management of PLL. Read More

Radiology 2020 May 24;295(2):458-466. Epub 2020 Mar 24.

From the Department of Radiology, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.

Background Abnormalities of the central lymphatic system (CLS) are increasingly treated by interventional radiology approaches. Planning of these procedures, however, is challenging because of the lack of clinical imaging tools. Purpose To evaluate the clinical usefulness of contrast agent-enhanced interstitial transpedal MR lymphangiography in the preinterventional workup of lymphatic interventions in patients with thoracic chylous effusions. Read More

Obes Surg 2020 Jun;30(6):2460-2461

Department of Specialized Surgery, King Abdullah Medical City, Makkah, Saudi Arabia.

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. Read More

Oxf Med Case Reports 2020 Feb 28;2020(2):omaa009. Epub 2020 Feb 28.

Department of Digestive Surgery, Nagano Municipal Hospital, Nagano, Japan.

An 84-year-old woman underwent subtotal stomach pancreatoduodenectomy (PD) for distal cholangiocarcinoma. Over 1000 ml of serous ascites, which appeared milky after starting a high-protein, low-fat, middle-chain triglyceride diet, was discharged from the inserted drain. On postoperative day (POD) 13, she underwent right hemicolectomy for transverse colonic volvulus, which occurred on POD 9 and was refractory to conservative therapies. Read More

In Vivo 2020 Mar-Apr;34(2):583-585

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Case Report: A 75-year-old man who underwent nivolumab as the third-line chemotherapy for advanced gastric cancer had chylous ascites (CA) after the primary tumor shrank remarkably. Total parenteral nutrition and subcutaneous octreotide were initiated, and CA disappeared. Nivolumab was continued for a total of 23 courses. Read More

Proc (Bayl Univ Med Cent) 2020 Jan 21;33(1):53-54. Epub 2019 Oct 21.

Department of Gastroenterology, State University of New York Upstate Medical UniversitySyracuseNew York.

Primary pancreatic lymphoma (PPL) is a rare entity, most likely to be clinically misdiagnosed as pancreatic adenocarcinoma. The cure rate of PPL is higher than that of adenocarcinoma. We present a case of PPL that presented as a pancreatic mass with chylous ascites and describe the incidence, clinical features, diagnostic approach, and most commonly used treatment regimens for PPL. Read More

Transl Androl Urol 2020 Jan;9(Suppl 1):S104-S113

Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.

Post-operative lymphatic injuries are uncommon but increase morbidity and mortality in vulnerable patient populations. Post-surgical lymphatic leaks are most commonly a consequence of radical neck dissection, esophagectomy, and lung cancer resections or retroperitoneal surgeries such as radical nephrectomy and lymphadenectomy. Injury may occur anywhere along the lymphatic chains with most serious leaks occurring along the axial skeleton between the inguinal region and the left venous angle. Read More

Radiol Case Rep 2020 Apr 5;15(4):371-374. Epub 2020 Feb 5.

Department of Radiology, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama 359-8513, Japan.

Lymphorrhea is a rare complication of rectal surgery. Although percutaneous embolization of thoracic or lymphatic ducts is now increasingly being reported for various types of lymphatic leakage, there are only sparse data on lymphatic interventions for lymphorrhea following rectal surgery. A novel balloon-occluded retrograde lymphatic embolization (BRLE) technique can be a simple and effective option for intractable lymphorrhea. Read More

Transplant Proc 2020 Mar 3;52(2):638-640. Epub 2020 Feb 3.

Avera McKennan Hospital & University Health Center, Avera Medical Group Transplant and Liver Surgery, Sioux Falls, South Dakota.

Chylous ascites (CA) is an uncommon entity with several etiologies. Only a few cases of CA have been reported as a complication after liver transplantation (LT). Most of these cases occurred within 1 month after surgery and typically resulted from traumatic intraoperative injury leading to disruption of lymphatics. Read More

Cir Esp 2020 Jan 24. Epub 2020 Jan 24.

Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, España.

J Assoc Physicians India 2020 Jan;68(1):69

Government Stanley Medical college.

Case Rep Gastrointest Med 2020 7;2020:7641476. Epub 2020 Jan 7.

Department of Internal Medicine, Saiseikai Kure Hospital, 2-1-13 Sanjo, Kure City, Hiroshima Prefecture 737-0821, Japan.

Most cases of chylous ascites occur after surgery, but it also develops in nonoperative cases, although rarely. Such cases are often difficult to treat. In this study, we treated 2 cases of atraumatic chylous ascites, which were controlled by combining diuretic treatment with an oral fat-free elemental diet (Elental®, EA Pharma Co. Read More

Ann Vasc Dis 2019 Dec;12(4):524-529

Department of Surgery, Division of Vascular Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan.

: The optimal surgical management for primary infected abdominal aortic aneurysm (IAAA) is controversial. Here, we report the early and long-term results of surgical treatments with the resection of the IAAA and in situ graft reconstruction with pedicled omental coverage that was performed at out hospital. : Between 2010 and 2017, 27 consecutive patients (26 males, 1 female, median age 69 years) with IAAA were surgically treated with the resection of the IAAA, in situ graft reconstruction and covered with a pedicled omental flap. Read More

J Ayub Med Coll Abbottabad 2019 Oct-Dec;31(4):506-511

Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.

Background: Chylothorax is an uncommon (3-8% risk) but potentially fatal complication of esophagectomy with poorly understood risk factors. It has a high morbidity due to loss of fluids, electrolytes, and other nutrients, loss of lymphocytes and immune dysfunction.

Methods: Retrospective chart review of adult patients who underwent esophagectomy between 2009 and 2016 was performed. Read More

BMJ Case Rep 2019 Dec 30;12(12). Epub 2019 Dec 30.

Pulmonary & Sleep Medicine, Avera Medical Group, Sioux Falls, South Dakota, USA.

We present a case of right sided chylothorax in the setting of cirrhosis believed to be secondary to extensive venous thromboembolism of the left upper extremity and exacerbated by chylous ascites. Our patient responded to conservative management with anticoagulation and a repeat thoracentesis revealed transformation of the fluid back to straw coloured transudate. We also include a brief discussion of the diagnosis and management of chylothorax. Read More

Gynecol Oncol 2020 02 29;156(2):511. Epub 2019 Dec 29.

Akdeniz University, Department of Ob&Gyn, Turkey.

Objective: Cisterna chyli is a pearl-shaped elongated lymphatic structure located at the level of L1-L2 vertebra just beneath the aorta (Hsu and Itkin, 2016 [1]). It receives lymphatic drainage of intestines and lower body structures (Loukas et al., 2007 [2]). Read More

Khirurgiia (Mosk) 2019 (12):100-105

Pirogov Russian National Research Medical University, Moscow, Russia.

Spontaneous chylous peritonitis during pregnancy is a rare disease. Only a few publications are currently devoted to this problem. The authors reported successful treatment of a patient with spontaneous chylous peritonitis in the first trimester of pregnancy. Read More

Case Rep Gastroenterol 2019 Sep-Dec;13(3):481-486. Epub 2019 Nov 21.

Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan.

We report the case of a 69-year-old man with a history of esophagogastric junction cancer (Barrett's esophageal cancer; pT1b [SM], N0, M0, pStage IA) that was surgically resected 2 years prior to the present episode. Recurrence was not observed during follow-up. Following complaints of dysphagia and abdominal pain, computed tomography revealed signs of internal hernia. Read More

J Surg Case Rep 2019 Nov 28;2019(11):rjz301. Epub 2019 Nov 28.

Upper GI and General Surgery, Monash Health, Clayton, VIC 3168, Australia.

We present an interesting and unusual case of a 57-year-old woman presenting with symptoms concerning for a bowel obstruction, and diagnostic imaging concerning for an internal hernia. The patient underwent an emergency laparotomy and was found to have chylous ascites throughout the abdomen, and the extravasation of chyle into the mesentery giving an appearance of a white mesentery. During this case, we will present all of the findings and discuss the unusual underlying pathology. Read More

J Minim Access Surg 2019 Dec 3. Epub 2019 Dec 3.

Upper Gastrointestinal Surgery Unit, St Vincent's Hospital, Melbourne, Victoria, Australia.

We present a case of chylous ascites in a 69-year-old man 5 months after a laparoscopic Toupet fundoplication (posterior 270°). This was successfully treated with laparoscopic ligation of tissue adjacent to the right crus. Laparoscopic ligation is a management option that should be considered after this rare complication, offering rapid results. Read More

Pediatr Gastroenterol Hepatol Nutr 2019 Nov 7;22(6):594-600. Epub 2019 Nov 7.

Department of Pediatrics, The University of Arizona College of Medicine, Tucson, AZ, USA.

With improving survival of children with complex congenital heart disease (CCHD), postoperative complications, like protein-losing enteropathy (PLE) are increasingly encountered. A 3-year-old girl with surgically corrected CCHD (ventricular inversion/L-transposition of the great arteries, ventricular septal defect, pulmonary atresia, post-double switch procedure [Rastelli and Glenn]) developed chylothoraces. She was treated with pleurodesis, thoracic duct ligation and subsequently developed chylous ascites and PLE (serum albumin ≤0. Read More

Surg J (N Y) 2019 Oct 21;5(4):e188-e191. Epub 2019 Nov 21.

Department of General Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.

 Acute pancreatitis is fraught with a variety of complications, which account for the mortality associated. Our case had a fulminant course, with three rare, near-fatal complications and was successfully managed conservatively. Pleural effusion due to pleuro-pancreatic fistula is uncommon, seen in only 1% cases, of which right-sided effusions are rarer still. Read More

Blood Res 2019 Sep 25;54(3):163. Epub 2019 Sep 25.

Department of Hematology, Sapporo Kyoritsu Gorinbashi Hospital, Sapporo, Japan.

J Gen Intern Med 2020 May 12;35(5):1586-1587. Epub 2019 Nov 12.

Department of Medicine, University of California, San Francisco, CA, USA.

Neonatal Netw 2019 Nov;38(6):357-364

Congenital chylothorax is defined as an abnormal accumulation of lymphatic fluid in the pleural space. It is a rare condition in the neonate that causes significant respiratory, nutritional, and immunologic problems resulting in a high mortality rate. Presented here is a case of congenital bilateral chylothorax in a preterm infant. Read More

Mayo Clin Proc 2019 12 2;94(12):e137-e143. Epub 2019 Nov 2.

Advisor to resident and Consultant in General Internal Medicine, Mayo Clinic, Rochester, MN. Electronic address:

J Pediatr Surg 2020 Apr 23;55(4):772-776. Epub 2019 Oct 23.

Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China. Electronic address:

Objective: Chylous ascites (CA) is a rare form of ascites that results from the leakage of lipid-rich lymph into the peritoneal cavity. In infants, CA is mostly caused by lymphatic malformation or unknown reasons. The creation of a shunt for the lymphorrhea is the last option for patients unresponsive to all other conservative treatments. Read More

JGH Open 2019 Oct 24;3(5):425-428. Epub 2019 Apr 24.

Department of General Surgery Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh India.

Background: Chyle leak is an uncommon form of ascites occurring due to the accumulation of lipid-rich lymph into the peritoneal cavity. Traumatic injury to the lymphatic system due to pancreaticobiliary surgery can lead to this phenomenon.

Method: We retrospectively evaluated the data of 159 patients of pancreticobiliary surgery from January 2012 to December 2016. Read More

Exp Clin Transplant 2019 Oct 11. Epub 2019 Oct 11.

From the Organ Transplantation Center, Imam Reza Hospital, Tabriz Medical Science University, Tabriz, Iran.

Kidney transplant is a choice option for treatment of chronic kidney failure because it is associated with cost-effective and normal quality of life. To increase the number of living kidney donors, laparoscopic and minimal invasive modalities have been introduced. Here, we present a case of a living donor with an extremely rare complication after laparoscopic donor nephrectomy that presented as massive chylous ascites. Read More