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.
The pyogenic liver abscess has an incidence of 1.1/1,000 habitants. Mortality can reach 100%. The use of less invasive procedures diminish morbidity and hospital stay.
Identify risk factors in patients who underwent percutaneous drainage guided by ultrasound as treatment.
Were analyzed 10 patients submitted to the method. Epidemiological characteristics, laboratory markers and imaging exams (ultrasound and CT) were evaluated.
The majority of the patients were men with mean age of 50 years old. Liver disease, alcoholism and biliary tract disease were the most common prodromes. Abdominal pain (90%), fever (70%) and jaundice (40%) were the most common clinical manifestations. Mortality of 20% was observed in this series. Hypoalbuminemia and days of hospitalization had a statistically significant positive association with death.
The pyogenic liver abscess has subacute evolution which makes the diagnosis difficult. Image exams have high sensitivity in diagnosis, particularly computed tomography. Percutaneous drainage associated with antibiotic therapy is safe and effective therapeutic resource.
Desenvolvido por Surya MKT