Rare case of chylous ascites following leparoscopic cholecystectomy reported

Dr Xiaoyun Cheng at Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College and colleagues have reported a rare case of chylous ascites after leparoscopic cholecystectomy.The case has been published in the BMC Surgery.

Lymphoscintigraphy could help in the easy localization and attribute the diagnosis to the proper source in a patient with atypical characteristics of chylous ascites. 

A known and frequently used surgical option for gallstone disease is Laparoscopic cholecystectomy as it has minimal trauma and rapid recovery. A relatively uncommon complication after laparoscopic cholecystectomy is Ascites and it is more frequently observed in patients with preoperative abnormal liver function. Refractory ascites after laparoscopic cholecystectomy rarely develops in patients without underlying liver disease. Cheng et al from China reported a case of massive ascites caused by lymphatic injury after laparoscopic cholecystectomy. 

The case was of a 63-year-old female who complained of abdominal discomfort and distension on the twelfth day after laparoscopic cholecystectomy for gallbladder stones. Eventually, there was spontaneous bacterial peritonitis and a decreased urine output. Abdominal effusion was identified by Abdominal computed tomography (CT). Abdominocentesis was done and about 1500–2000 ml per day volume of slightly turbid yellow ascites was retrieved. Laboratory analysis of ascitic fluid showed the following: 

As the patient's symptoms did not relieve after the diuretic therapy despite the repeated large-volume paracentesis with albumin supplementation, administration of antibiotics, and renal vasodilating medications, Lymphoscintigraphy was done which found a small amount of radioactive filling in the abdominal cavity. After detecting the leak, the patient received surgery, and the lymphatic leak was ligated. Then the ascites disappeared, and the patient recovered well. 

Thus, through this case, the authors highlighted the importance of lymphoscintigraphy that could help to localize and give a qualitative diagnosis in patients with atypical characteristics of chylous ascites. They also added that Surgical treatment could be considered when conservative treatment fails. 

To read the full article, click here: https://doi.org/10.1186/s12893-022-01758-x

Cheng, X., Huang, J., Yang, A. et al. Refractory ascites after laparoscopic cholecystectomy: a case report. BMC Surg 22, 317 (2022).