Abstract
A 73-year-old woman with a medical history of varix of the lower extremity underwent laparoscopic assisted distal gastrectomy (LADG) for early gastric cancer. As the patient was associated with chylous ascites postoperatively, fasting and administration of octreotide were started. On the postoperative day 10, the patient suddenly complained of discomfort of the anterior thoracic region and went into shock. Pulmonary embolism was diagnosed and administration of heparin was started. However, her chylous ascites was intractable and the conservative therapy was unsuccessful. Pulmonary embolism tended to improve, but thrombi had still remained in the bilateral pulmonary arteries. Surgical therapy for chylous ascites in such a patient was considered too hazardous. When about two months had passed after the operation, however, drained discharge amounted to more then 1 L per day. So we performed surgery on the 59th postoperative day. Ensure liquid was administered before and during the surgery to identify a leaking site that was ligated. After confirming no bleeding 24 hours after the surgery, we resumed heparin administration. Chylous ascites cured and pulmonary embolism also improved after the surgical treatment.
