The management of postoperative chylous ascites. A case report and literature review

Chylous ascites remains rare as a complication of surgical intervention. Although therapeutic manoeuvres to control chylous ascites have been developed over the past 20 years, its pathophysiology is poorly understood. Conservative approaches involving dietary restriction of long-chain triglycerides and salt, together with multiple paracenteses, are still the therapies of choice. Persistent chylous ascites may be treated surgically by ligation of leaking lymphatics or implantation of a peritoneovenous shunt once the lymphatic anatomy has been defined by preoperative investigations. We report a case of chylous ascites developing after laparotomy and duodenotomy for obscure gastrointestinal bleeding, which did not respond adequately to medical therapy and was successfully managed by the insertion of a peritoneovenous shunt.