腹腔鏡下単純子宮全摘術後に乳糜腹水を発症した１例

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We recently encountered a case of postoperative chylous ascites after total laparoscopic hysterectomy for uterine leiomyoma. The case involved a 47-year-old woman who had undergone total laparoscopic hysterectomy and bilateral salpingectomy for leiomyoma of the uterus. Histopathological examination revealed leiomyoma without any malignant tumors. The patient was referred to our hospital, where she presented with a considerable amount of milky white ascites. After excluding carcinomatous peritonitis, ureter rauma, bowel injury, and bacterial peritonitis, we made the diagnosis of chylous ascites due to a high level of triglycerides in the ascites. Oral feeding of the patient was stopped, and she received intravenous hyperalimentation and subcutaneous injection of octreotide. The presence of ascites decreased gradually and eventually disappeared after restart of food intake. Recurrence of the ascites was not observed. Most cases of chylous ascites after gynecologic surgery involve patients who have undergone retroperitoneal lymph node dissection. However, there has been no case of chylous ascites after benign gynecologic surgery. When ascites are found after benign gynecologic surgery, not only carcinomatous peritonitis, ureter trauma, bowel injury and bacterial peritonitis, but also chylous ascites, should be considered.