Develing L, Hamming J F, Speelberg B
Afd. Intensive Care, St. Elisabeth Ziekenhuis, Tilburg.
Ned Tijdschr Geneeskd. 2003 Aug 2;147(31):1513-6.
Two patients, a man aged 65 years and a woman aged 75 years, developed chylous ascites after emergency abdominal aortic aneurysm repair. Both patients were still on artificial ventilation at the time of diagnosis. The first symptoms were high ventilation pressure, elevated diaphragm and abdominal distension. The patients were treated conservatively with drainage, and the man was also given tube feeding without long-chain triglycerides. The man recovered, while the woman died of sepsis. Chylous ascites is an unusual complication of retroperitoneal surgery. Abdominal paracentesis is a simple means to confirm the diagnosis. Initial treatment consists of draining the chylus, and a medium-chain triglyceride diet or total parenteral nutrition. When this fails, more invasive treatment is required, consisting of direct lymphatic repair or peritoneovenous shunting. In mechanically ventilated patients, gradually progressive symptoms of abdominal hypertension after surgery in the retroperitoneal space should arouse suspicion of this complication.
