Mesenteric Lymphangiography as a New Diagnostic and Therapeutic Tool for Refractory Chylous Lymphatic Leakages and Protein-Losing Enteropathy.

Purpose: To evaluate whether mesenteric lymphangiography (mLAG) is technically feasible and clinically useful for patients with refractory chylous ascites, chylothorax, and protein-losing enteropathy (PLE).

Materials and methods: A retrospective study of 35 patients (male, 16; female, 19; mean age, 56 years; range, 20-78 years) who underwent mLAG at 2 institutions between March 2016 and July 2022 was performed. mLAG was performed via intraoperative and/or percutaneous approaches. Imaging findings were categorized into 3 types: Type 0 (technical failure), Type 1 (limited to mesentery), or Type 2 (central propagation). Auxiliary findings including lymphangiectasia, reflux, and leakage were recorded. Interventions included mesenteric lymph node embolization (mLNE), retroperitoneal lymph node embolization, lymphoplasty, and lymphovenous shunt creation.

Results: Among 35 patients, 27 presented with refractory chylous ascites and/or chylothorax and 8 with PLE. Of the 35 patients, mLAG was performed percutaneously in 21 (60%) patients, intraoperatively in 9 (26%), and both percutaneously and intraoperatively in 5 (14%) patients. The findings were classified as Type 0 in 4 (11%), Type 1 in 8 (23%), and Type 2 in 23 (66%). Of 35 patients, the auxiliary findings of lymphangiectasia (E), reflux (R), and leakage (L) were observed in 20% (n = 7), 23% (n = 8), and 6% (n = 2), respectively. mLNE was performed in 14 patients. Clinical improvement was achieved in 57% (20 of 35) of the patients. One patient developed bowel wall edema post-mLNE; no other severe adverse event was reported.

Conclusions: mLAG is technically feasible and safe. It can be a useful tool to image the mesenteric lymphatics or perform mesenteric lymphatic embolization.