腹腔镜Roux-en-Y胃旁路术后长期胆绞痛掩盖乳糜性腹水：一例报告
Long standing biliary colic masking chylous ascites in laparoscopic roux-en-Y gastric bypass; a case report.
作者信息
Zaidan Louai R, Ahmed Elhaitham K, Halimeh Bachar, Radwan Yasser, Terro Khalil
机构信息
Alfaisal University, Riyadh, Saudi Arabia.
Specialized Medical Center Hospital, Riyadh, Saudi Arabia.
出版信息
BMC Surg. 2018 Jun 19;18(1):43. doi: 10.1186/s12893-018-0374-7.
BACKGROUND
Chylous ascites is considered to be an intra-abdominal collection of creamy colored fluid with triglyceride content of > 110 mg/dL. Chylous ascites is an uncommon but serious complication of numerous surgical interventions. However, it is a rare complication of LRYGB. An internal hernia limb defect is thought to be the underlying etiology, where the hernia will cause lymphatic vessel engorgement and lymphatic extravasation.
CASE PRESENTATION
We report a case of a 29 years old male with a 9 year history of laparoscopic Roux en y gastric bypass (LRGYB), presenting with recurrent abdominal pain for 2 months radiating to the right shoulder. Ultrasound examination revealed gallstones and the patient was subsequently admitted for laparoscopic cholecystectomy. Intraoperatively, whitish colored fluid, high in triglycerides content was aspirated. During exploration, an internal hernia limb defect was found and corrected.
CONCLUSION
Post LRGYB patients with symptoms of recurrent abdominal pain should be suspected for chylous ascites reflecting an internal hernia.
背景
乳糜性腹水被认为是腹腔内积聚的呈乳脂色的液体，甘油三酯含量>110mg/dL。乳糜性腹水是众多外科手术中一种不常见但严重的并发症。然而，它是腹腔镜Roux-en-Y胃旁路术（LRYGB）的一种罕见并发症。内部疝肢体缺损被认为是潜在病因，疝会导致淋巴管充血和淋巴外渗。
病例报告
我们报告一例29岁男性，有9年腹腔镜Roux-en-Y胃旁路术（LRGYB）病史，出现复发性腹痛2个月，疼痛放射至右肩。超声检查发现胆结石，患者随后因腹腔镜胆囊切除术入院。术中吸出了甘油三酯含量高的白色液体。探查时发现并纠正了一个内部疝肢体缺损。
结论
LRGYB术后出现复发性腹痛症状的患者应怀疑有乳糜性腹水，提示存在内部疝。
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