Li Ying, Tai Yang, Wu Hao
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastrointest Surg. 2024 Jul 27;16(7):2343-2350. doi: 10.4240/wjgs.v16.i7.2343.
Chylous ascites is caused by disruption of the lymphatic system, which is characterized by the accumulation of a turbid fluid containing high levels of triglycerides within the abdominal cavity. The two most common causes are cirrhosis and tuberculosis, and colon signer ring cell carcinoma (SRCC) due to the use of immunosuppressants is extremely rare in cirrhotic patients after liver transplantation, making it prone to misdiagnosis and missed diagnosis.
A 52-year-old man who underwent liver transplantation and was administered with immunosuppressants for 8 months was admitted with a 3-month history of progressive abdominal distention. Initially, based on lymphoscintigraphy and lymphangiography, lymphatic obstruction was considered, and cystellar chyli decompression with band lysis and external membrane stripping of the lymphatic duct was performed. However, his abdominal distention was persistent without resolution. Abdominal paracentesis revealed allogenic cells in the ascites, and immunohistochemistry analysis revealed adenocarcinoma cells with phenotypic features suggestive of a gastrointestinal origin. Gastrointestinal endoscopy was performed, and biopsy showed atypical signet ring cells in the ileocecal valve. The patient eventually died after a three-month follow-up due to progression of the tumor.
Colon SRCC, caused by immunosuppressants, is an unusual but un-neglected cause of chylous ascites.
乳糜性腹水是由淋巴系统破坏引起的，其特征是腹腔内积聚含有高水平甘油三酯的浑浊液体。最常见的两个原因是肝硬化和结核病，而由于使用免疫抑制剂导致的结肠印戒细胞癌（SRCC）在肝移植后的肝硬化患者中极为罕见，容易误诊和漏诊。
一名52岁男性，接受肝移植并使用免疫抑制剂8个月，因进行性腹胀3个月入院。最初，根据淋巴闪烁造影和淋巴管造影，考虑为淋巴阻塞，并进行了淋巴管带松解和淋巴管外膜剥脱的乳糜池减压术。然而，他的腹胀持续未缓解。腹腔穿刺术显示腹水中有异型细胞，免疫组化分析显示为具有胃肠道起源表型特征的腺癌细胞。进行了胃肠内镜检查，活检显示回盲瓣有非典型印戒细胞。患者最终在三个月的随访后因肿瘤进展死亡。
由免疫抑制剂引起的结肠SRCC是乳糜性腹水的一种不寻常但不可忽视的病因。
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