Peritoneovenous Shunting to Manage Chylous Ascites Following Liver Resection for Cholangiocarcinoma: A Case Report

TL;DR

A patient developed chylous ascites after liver surgery for cholangiocarcinoma and was successfully treated with a peritoneovenous shunt when conservative methods failed.

Contribution

This case report highlights peritoneovenous shunting as an effective treatment for refractory chylous ascites following liver resection.

Findings

Chylous ascites after liver resection can be managed with peritoneovenous shunting when conservative therapies fail.

The patient's clinical status improved after shunting with no major complications.

Conservative measures like dietary changes and octreotide were insufficient for long-term resolution.

Abstract

Liver resection has rarely been reported as a cause of chylous ascites. Such ascites, consisting mainly of hepatic lymph, is usually caused by injury to the lymphatic system between the hepatic hilum and the hepatoduodenal ligament. We report a patient who developed chylous ascites after liver resection and required a peritoneovenous shunt.

An 80-year-old man with a liver tumor diagnosed as cholangiocarcinoma underwent an extended right hemihepatectomy with lymphadenectomy following right portal vein embolization. Postoperatively, he developed chylous ascites that resolved with dietary measures, bowel rest, and administration of octreotide. However, he was readmitted a month after discharge with abdominal distension and dyspnea from massive ascites and pleural effusion. Abdominal paracentesis confirmed chylous ascites, showing a triglyceride concentration of 614 mg/dL. After failure of conservative therapy, including dietary and pharmacologic interventions, peritoneovenous shunting was performed. Clinical status improved after shunting, with no adverse events except for transient fever.

Refractory chylous ascites after liver resection should be treated promptly with surgical measures such as peritoneovenous shunting to maintain the patient’s general condition.

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