Abstract
Chylous ascites associated with radical resection of gastric cancer is a serious clinical condition. Lymph node dissection is indispensable during gastrectomy for gastric cancer. However, postoperative chylous ascites prolongs the hospital stay and re-operation. There are few reports on this subject. Most of these ascites cases usually subside untreated, but can cause significant morbidity. However, the definition of chylous ascites is ambiguous, and the reports on it in English literature vary.
In this report, we discuss a 68-year-old man who underwent distal gastrectomy for early gastric cancer at our hospital who was admitted 8 months after the surgery with a main complaint of abdominal swelling. An abdominal puncture helped to diagnose him with chylous ascites with markedly elevated triglyceride levels. The patient received a hypercaloric infusion through a central line, and octreotide acetate, but without improvement in the patient's condition. After assessment of the lymph outflow using lymph scintigraphy, surgical ligation of the lymph vessels was performed through laparotomy. The volume of the milky-white ascites was 3,000 ml in the abdominal cavity. Macroscopically, a milky white fluid was confirmed as flowing from behind the common hepatic artery, and ligation was consequently performed. The patient's chylous ascites has not recurred in the 12 months after the re-operation.
In summary, we discuss a case of postoperative chylous ascites after radical gastrectomy for gastric cancer that was successfully treated through surgery. We further review and report on the existing literature on this subject.
