Chylous drainage through percutaneous cholecystostomy: an extremely rare complication

TL;DR

A rare case of chyle leak occurred after a percutaneous cholecystostomy in a patient with advanced cancer and a complex surgical history.

Contribution

This is the first reported case of chylous drainage following percutaneous cholecystostomy.

Findings

Chylous output was observed after percutaneous cholecystostomy tube placement in a 67-year-old female.

The patient's hospital course was complicated by persistent distributive shock and adrenal insufficiency.

The patient ultimately transitioned to hospice and died shortly after.

Abstract

Chyle leak is a rare but potentially morbid complication of abdominal surgery. There have been seven reported cases of chylous ascites following cholecystectomy, but no such occurrences are reported with percutaneous cholecystostomy tube (PCT) insertion. We report the case of a 67-year-old female with stage IVb recurrent uterine papillary serous carcinoma and extensive abdominal surgical history including a paraesophageal hernia repair, and a robotic hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, gastrocolic omentectomy, and hepatoduodenal lymphadenectomy. The patient presented with clinical findings suggestive of acute cholecystitis and decision was made to proceed with PCT placement. The PCT was dislodged and replaced during her course and several days after chylous output was noted from the PCT. The remainder of her hospital course was complicated by persistent distributive shock, adrenal insufficiency, and continued chyle leak. She ultimately was transitioned to inpatient hospice and died shortly after.

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