Abstract
The patient was a 64-year-old man with a medical history of distal gastrectomy for gastric cancer. He came to our hospital with the chief complaint of sudden hypogastrium pain after a meal. When he came to our hospital, he had peritonitis, and his abdominal enhanced CT revealed an expanded small intestine and whirl-like sign that led us to diagnose him with a strangulated ileus. An emergency operation was performed. When we opened the abdominal cavity, chylous ascites was discharged and many fine white linear structures were observed on the mesentery, which appeared to be lymph vessels. Torsion of the small intestine was caused by the adhesion around the superior mesenteric artery. We released the torsion by avulsion. As there were no findings of necrosis on the twisted small intestine, we did not perform an enterectomy. The ascites was milk-colored and the value of neutral fat in that ascites was high : 363 mg/dL. Based on this finding, we believed that the ascites was chylous ascites. His progress after the operation was good and he left our hospital 7 days after the operation. There have been only 12 reports of strangulated ileus with chylous ascites in Japan, including our case. However, in all of these 12 cases, though the obvious findings of strangulated ileus were present, enterectomy could be avoided because of the absence of necrosis. From these facts, we assume that the existence of chylous ascites may suggest the possibility of conservation of a strangulated intestine.
