Chylous ascites occurring after low anterior resection of the rectum successfully treated with an oral fat-free elemental diet (Elental(®)).
Chylous ascites occurring after low anterior resection of the rectum successfully treated with an oral fat-free elemental diet (Elental(®)).
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DOI：
10.1007/s12328-012-0304-7
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发表时间：
2012-06
影响因子：
1
通讯作者：
Togo, Shinji
中科院分区：
文献类型：
--
作者：
Nakayama, Gakuryu;Morioka, Daisuke;Murakami, Takashi;Takakura, Hideki;Miura, Yasuhiko;Togo, Shinji
腹部手术后发生乳糜性腹水是罕见的。尽管有潜在的危险，但由于其罕见性，没有明确的治疗指南。在此我们提出一个直肠手术后发生大量乳糜性腹水的病例，经口服无脂元素饮食（艾德）成功治疗。一名67岁男性因晚期直肠癌接受了低位前切除术和腹主动脉旁淋巴结切除术。术后早期病程顺利，患者于术后10天出院;然而，出院后，腹胀迅速发展。术后3周行腹部计算机断层扫描（CT）显示大量腹水，实验室检查结果显示明显的低蛋白血症和淋巴细胞减少症。紧急诊断性穿刺术显示腹水为含有高水平甘油三酯（564 mg/dl）的白色乳状液体，从而诊断为乳糜腹膜。患者的每日营养完全是无脂艾德（30 kcal/kg/天Elental®，Ajinomoto Pharmaceutical Co. Ltd，Tokyo，Japan）。开始口服Elental®后，腹胀、低蛋白血症和淋巴细胞减少症逐渐改善。术后7周进行的腹部CT显示腹部无腹水，此后开始正常饮食。从那时起，没有复发乳糜腹膜已被证明。结果，乳糜腹水在门诊得到了成功治疗。
Chylous ascites occurring after abdominal surgery is rare. Despite being potentially critical, there is no definite treatment guideline because of its rarity. Here we present a case of massive chylous ascites occurring after rectal surgery which was successfully treated with an oral fat-free elemental diet (ED). A 67-year-old man underwent low anterior resection with para-aortic lymphadenectomy for advanced rectal cancer. Early postoperative course was uneventful and the patient was discharged from hospital 10 days after surgery; however, after discharge, abdominal distension rapidly developed. Abdominal computed tomography (CT) performed 3 weeks after surgery revealed massive ascites and laboratory findings showed remarkable hypoproteinemia and lymphopenia. Urgent diagnostic paracentesis showed the ascites to be a white milky fluid containing high levels of triglycerides (564 mg/dl), leading to a diagnosis of chyloperitoneum. Daily nutrition of the patient was entirely with a fat-free ED (30 kcal/kg/day of Elental®, Ajinomoto Pharmaceutical Co. Ltd, Tokyo, Japan). After the initiation of oral Elental®, abdominal distension, hypoproteinemia, and lymphopenia gradually improved. Abdominal CT performed 7 weeks after surgery showed no ascitic fluid in the abdomen, and thereafter a normal diet was initiated. Since then, no relapse of chyloperitoneum has been proven. As a result, the chylous ascites was successfully treated in the outpatient clinic.