Abstract
A case of intra-abdominal local recurrence that was diagnosed during the seventh month after surgery for pancreatic cancer due to the appearance of delayed chylous ascites is reported. The patient was a 73-year-old man who was diagnosed with pancreatic head carcinoma based on detailed examinations conducted for abdominal pain, and he underwent subtotal stomach-preserving pancreaticoduodenectomy. The histopathological diagnosis was poorly-differentiated adenocarcinoma, T3, N2, Stage IVa. Adjuvant chemotherapy with S-1 was given postoperatively, but it was stopped after four courses due to side effects. Computed tomography (CT) performed during the sixth postoperative month showed only a small amount of ascitic fluid. Abdominal paracentesis performed due to increased abdominal distention during the seventh postoperative month showed milky ascitic fluid, and chylous ascites was diagnosed. Administration of octreotide 300 μg/day was started, and three days later, decreases in ascitic fluid and in triglyceride levels in the drainage fluid were observed. Because subsequent CT showed findings of recurrence around the superior mesenteric artery, chemotherapy with gemcitabine was begun. Chylous ascites has often been reported to occur in the early postoperative stage, but the present case suggests that it may occur with a delayed onset due to causes such as intra-abdominal local recurrence.
