A 79-year-old male underwent partial pancreatectomy for an intraductal papillary mucinous tumor, and seven years later, a residual pancreatectomy for pancreatic head cancer. Two months after the second surgery, the patient developed abdominal distension, and an ascitic puncture revealed 3 L of chylous ascites. Conservative treatments, including a low-fat diet and somatostatin analog therapy, were ineffective, leading to referral.
Lymphoscintigraphy indicated an abdominal lymphatic duct injury, with lymph flow from the lower extremities contributing to the ascites. Surgical ligation of the leaking lymphatic duct via laparotomy was considered; however, the precise leakage site was difficult to identify, making direct ligation impractical. As an alternative, lymphaticovenular anastomoses (LVAs) were performed in the lower extremities. Four LVAs were successfully completed, resulting in the resolution of chylous ascites within three months postoperatively.
This case demonstrated that the LVAs created effective bypasses distal to the leakage point, reducing lymphatic flow at the lesion and enabling its closure. LVAs offer a minimally invasive and effective treatment for refractory chylous ascites, particularly in cases in which lymphatic flow from the lower extremities contributes to this condition.
