Abstract
A 74-year-old man underwent distal gastrectomy, D1 + with No.14v lymph node dissection, and Roux-en Y reconstruction for advanced gastric cancer with infiltration into the transverse mesocolon. When about 2 weeks had elapsed after initiation of adjuvant chemotherapy, he developed abdominal distention. Ascites was confirmed by a CT scan undertaken 3 months after the surgery. Abdominal paracentesis yielded a milky white ascites with remarkably elevated triglyceride level. Chylous ascites was thus diagnosed. Since conservative therapy was unsuccessful, he was referred to our hospital for further treatments 7 months after the surgery. Plain abdominal CT scan performed immediately after lymphangiography revealed leakage of lipiodol around the celiac artery and/or common hepatic artery. Upon laparotomy, we ligated and sutured the chylorrhea site to close the chylorrhea by using an absorbable tissue-reinforcing material and a physiological tissue adhesive.
Prolonged chylorrhea for a long time extremely worsens the general condition of the patient. When we encounter refractory chylous ascites, it is important to perform surgical therapy without hesitation that can lead to a curative therapy.
