A Case of Chylous Ascites Associated with an Internal Hernia of the Small Bowel after Total Gastrectomy

Abstract

An 88-year-old man who developed sudden onset of abdominal pain after eating lunch was transferred to our hospital. He had undergone total gastrectomy for gastric cancer five years previously. Computed tomography revealed ascites, distention of the small bowel, and signs of closed loop obstruction, suggesting a strangulated ileus. Ultrasound-guided paracentesis showed milky chylous ascites. He underwent emergency laparotomy, and intraoperative findings showed chylous ascites and torsion of almost the entire small bowel into a mesenteric defect at the previous jejuno-jejunostomy. Although the incarcerated small bowel was congested, the color and peristalsis of the small bowel improved after release of the strangulation. Thus, the small bowel was preserved without resection. The patient had an uneventful postoperative recovery and was discharged on postoperative day 19. There have been only 8 cases, including the present patient, of chylous ascites associated with small bowel obstruction reported in Japan. All patients underwent surgery, but bowel resection was avoided in all cases. We recommend emergent surgery for a patient with strangulated ileus presenting with chylous ascites.