LIPIODOL LYMPHANGIOGRAPHY AND EMBOLIZATION OF CHYLOUS ASCITES AFTER PANCREATODUODENECTOMY

INTRODUCTION

Chylous ascites is a rare disorder characterized by the accumulation of triglyceride-rich fluid in the abdominal cavity due to the disruption of the lymphatic system²,³,¹¹. A variety of conditions can cause chylous ascites, including congenital lymphatic abnormalities, inflammatory and infectious conditions, liver cirrhosis, malignancies, cardiogenic trauma, and iatrogenic injury postsurgery²,⁸. The fluid of chylous ascites has a “milky” appearance, and the triglyceride content is over 110 mg/dL²,¹¹. Chylous ascites cause mechanical symptoms related to abdominal distension and may lead to malnutrition and impairment of the immune system that is associated with morbidity and mortality. The prognosis is different in chylous ascites and can be fatal depending on the underlying cause. High mortality rates have been observed in up to 90% of patients with cancer if not treated properly¹,⁴,¹¹.

There is no standardized treatment of chylous ascites, and the current management includes high-protein and low-fat diet as conservative treatment, total parenteral nutrition (TPN), paracentesis, radiology, and surgical interventions. Lymphangiography and percutaneous embolization are a less invasive procedure and have been reported to have a therapeutic effect in 56–86% of patients with lymphatic leaks¹,². Intranodal lymphatic embolization has been previously described in the treatment of some visceral lymphatic leaks¹,⁵,¹³. This study aimed to present a case of chylous ascites after pancreatoduodenectomy treated with lipiodol lymphangiography and embolization.