Long-term conservative treatment of chylous ascites in gynecological malignant surgery: a case report and literature review.

Abstract

Chylous ascites is a rare complication of abdominal surgery. Although most patients show improvement with conservative treatment. Long-term leakage of chylous ascites can cause malnutrition, dehydration, and immunosuppression; therefore, an early cure is desirable, but no standard treatment for chylous ascites has been established, and determining the timing of surgical intervention is difficult. A 74-year-old woman underwent surgery for carcinosarcoma of the fallopian tube, including dissection of the pelvic and para-aortic lymph nodes. She was noted to have a large amount of chylous ascites postoperatively. Furthermore, a low-fat diet, weekly ascites punctures and lymphangiography were performed. However, the leakage was not resolved. After ten weeks of intensive treatment with fasting, total parenteral nutrition (TPN), octreotide, etilefrine, and fibrogammin, beginning 18 weeks postoperatively, the chylous ascites changed to serous and disappeared. Long-term conservative treatment may improve chylous ascites, and continued conservative treatment without surgical intervention is an option. The patient was resistant to a low-fat diet, although fasting and TPN were effective. In addition, a change in the color of the ascites from milky white to serous as a precursor to improvement of the erosive ascites may help to consider the timing of surgical intervention.