Abstract
A case of intractable ascites due to hepatic lymphorrhea following total gastrectomy, splenectomy and lymph node dissection for a malignant tumor of the stomach is described. Since the 6th day after the operation, the daily amount of ascites from the drainage tube increased from 500 to 1100 ml. There was no tendency of healing by the conservative therapy, and the patient was reoperated on.
With the P-V shunt in the second operation, the abdominal symptoms were alleviated, however, this procedure was suspended because of fever, leukocytosis and abnormal ranges of coagulo-fibrinolic system. In the last operation, sprinking of antibiotics over the portion of lymphorrhea and irrigation of abdominal cavity were performed. Owing to these procedures, intractable lymphorrhea lasting 117 days disappeared. In the dissection of hepatoduodenal ligament, it is important to consider so as not to congest the current of the lymph and to ligate the lymphatic vessels.
