CHYLOPERITONEUM: DIAGNOSTIC AND THERAPEUTIC OPTIONS

Abstract

Chyloperitoneum is not rare and is often
associated with other chylous disorders
particularly in more complex clinical
conditions. An accurate diagnostic study is
indispensable to plan the correct therapeutic
approach, and we examined the long-term
outcomes of our experience in the
management of primary and secondary
chyloperitoneum in fifty-eight patients
(50 adults and 8 children; 34 primary and 24
secondary forms). Diagnostic assessment
consisted of paracentesis, whole body
lymphoscintigraphy, lymphangio-MR, and
lymphangio-CT (LAG-CT). The management
of chyloperitoneum consisted initially of
non-operative procedures (MCT diet, TPN,
octreotide). Surgical treatment was performed
in patients not responsive to conservative
methods and involved different options using
surgical and microsurgical approaches.
Microsurgical techniques included chylousvenous
shunts connecting chyliferous vessels
and mesenteric veins. Fibrin glue or platelet
gel injection at the site of the chylous leakage
was also used to treat one case of refractory
secondary chyloperitoneum. Patients were
followed clinically and instrumentally
(echography and labs tests) for 6 months to
over 5 years. We found that LAG-CT was the
primary diagnostic modality to provide precise
topographic information concerning the site,
cause, and extension of chylous pathology,
all of which allowed proper planning of
therapeutic procedures. Thirty-four patients
did not have a relapse of the chyloperitoneum
and 22 patients had a persistence of a small
quantity of ascites with no protein imbalance.
We observed early relapse of chylous ascites in
2 cases that required a peritoneal-jugular
shunt leading to good outcomes. An accurate
diagnostic study (above all LAG-CT) and a
microsurgical approach proved to represent
an effective management of chyloperitoneum
refractory to non-operative treatment.