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Phlebologie 2010; 39(01): 24-27
DOI: 10.1055/s-0037-1622291
Case report
Schattauer GmbH

Peritoneo-venous shunt implantation as a therapy for chylous ascites

Peritoneovenöse Shunt-Implantation als Behandlungs ansatz für chylöse Aszites
G. Tasnádi
1   Paediatric Surgery Department, Heim Pál Hospital, Budapest, Hungary
,
I. Bihari
2   Semmelweis University College, Budapest, Hungary
,
P. Bihari
1   Paediatric Surgery Department, Heim Pál Hospital, Budapest, Hungary
› Author Affiliations
Further Information

Publication History

Received: 18 August 2009

accepted: 26 November 2009

Publication Date:
05 January 2018 (online)

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Summary

We report a case of primary chylous ascites in a progressively poor condition with proteinlosing enteropathy, pleural and pericardiac effusion. Therapy: Denver peritoneo- venous shunt was implanted. Three years later the patient became septic and the shunt was removed. Clinical course: Soon after implantation the patient’s condition improved, and in two months he lost 51 kg. After three years fibrinous occlusion of the shunt and sepsis developed. The occlusion could be dissolved with streptokinase. Removing the shunt cured the patient’s septic state. The chylous ascites did not recur. Conclusion: In emergency cases implantation of a peritoneo-venous shunt leads to a rapid relief of the state. Usually this is a palliative treatment, but in this case it gave a final result. Fibrin can deposit on or occlude the drain which can be solved without further complications. If the patient is septic the drain must be removed and the septic state ends.

Zusammenfassung

Fallbericht über einen Patienten in schlechtem Allgemeinzustand bei primärem Aszites chylosus mit eiweißverlierender Enteropathie sowie Pleura- und Perikarderguss. Therapie: Ein peritoneovenöser Shunt wurde implantiert. Drei Jahre später musste das Implantat wegen einer Shuntsepsis entfernt werden. Verlauf: Nach der Implantation des Shunts verbesserte sich der Zustand des Patienten rasch hatte der Patient bereits 51 kg abgenommen. Drei Jahre nach Implantation des Shunts kam es zu einem fibrinösen Verschluss desselben, woraus sich im weiteren Verlauf eine Shunt-Sepsis entwickelte. Der Shunt-Verschluss konnte mit Fibinolytika aufgelöst werden. Die Sepsis wurde durch Entfernung des Implantats geheilt. Der Ascites chylosus ist nach dem Entfernen des Implantats nicht erneut aufgetreten. Schlussfolgerung: In Notfallsituationen bei einem Ascites chylosus kann die Implantation eines peritoneovenösen Shunts den Zustand des Patienten verbessern. Dies ist in den meisten Fällen als palliative Therapie anzusehen, jedoch erwies es sich in diesem Fall als dauerhafte Lösung. Fibrin kann sich im Shunt ablagern oder den Shunt verschließen, was aber mit Fibrinolytika ohne weitere Komplikationen aufgelöst werden kann. Beim Auftreten einer Shunt-Sepsis muss das Implantat entfernt werden und durch diesen Eingriff kann die Sepsis geheilt werden.

Keywords

Chylous ascites - peritoneo-venous shunt - septic state - primary lymphatic disease

Schlüsselwörter

Aszites chylosus - peritoneovenöser Shunt - Shunt-Sepsis - Erkrankung
 

  • References

  • 1 Aalami OO, Allen DB, Organ CH. Chylous ascites: A collective review. Surgery 2000; 128: 761-778.
    CrossrefPubMedGoogle Scholar
  • 2 Boyd WD, McPhail NV, Barber GC. Chylous ascites following abdominal aortic aneurysmectomy: Surgical management with a peritoneovenous shunt. J Cardiovasc Surg 1989; 30: 627-629.
    Google Scholar
  • 3 Browse NL, Wilson NM, Russo F, Al-Hassan H, Allen DR. Aetiology and treatment of chylous ascites. Br J Surg 1992; 79: 1145-1150.
    CrossrefPubMedGoogle Scholar
  • 4 Busch T, Lofti S, Sirbu H. et al. Chyloperitoneum: a rare complication after abdominal aortic aneurysm repair. Ann Vasc Surg 2000; 14: 174-175.
    CrossrefPubMedGoogle Scholar
  • 5 Campisi C, Bellini C, Eretta C. et al. Diagnosis and management of primary chylous ascites. J Vasc Surg 2006; 43: 1244-1248.
    CrossrefPubMedGoogle Scholar
  • 6 Chang JHT, Newkirk J, Carlton G, Miller Jd, Orsini E. Generalized lymphangiomatosis with chylous ascites – treatment by peritoneo-venous shunting. J Pediatric Surg 1980; 15: 748-750.
    CrossrefPubMedGoogle Scholar
  • 7 Crespo-Leiro MG, Ayucar A, Portela F, Cuenca JJ, Juffé A, Hermida LF, Castro-beiras A. Chylous ascites following heart transplantation. J Cardiovasc Surg 1998; 39: 217-295.
    Google Scholar
  • 8 Fleisher HL, Oren JW, Sumner DS. Chylous ascites after abdominal aortic aneurysmectomy: Successful management with a peritoneovenous shunt. J Vasc Surg 1987; 6: 404-407.
    Google Scholar
  • 9 Földi M, Kubik S. Lehrbuch der Lymphologie. Stuttgart, Jena, New York: Gustav Fischer; 1991: 310-311.
    Google Scholar
  • 10 Gloviczki P. Invited commentary. Primary chylous ascites. J Vasc Surg 2006; 43: 1297-1298.
    CrossrefPubMedGoogle Scholar
  • 11 Haug ES, Saether OD, Odegaard A, Johnsen G, Myhre HO. Chylous complications after abdominal aortic surgery. Internat Angiol 1998; 17: 244-247.
    Google Scholar
  • 12 Heinisch HM. Pediatric Lymphangiology. In: Földi M, Casley-Smith JR. (eds). Lymphangiology. Stuttgart: Schattauer; 1983: 778-810.
    Google Scholar
  • 13 Kaas R, Rustman LD, Zoetmulder FAN. Chylous ascites after oncological abdominal surgery: incidence and treatment. Eur J Surg Oncol 2001; 27: 187-189.
    CrossrefPubMedGoogle Scholar
  • 14 Kinmonth JB. Disorders of the circulation of chyle. J Cardiovasc Surg 1976; 17: 329-339.
    Google Scholar
  • 15 Kuroiwa M, Toki F, Suzuki M, Suzuki N. Successful laparoscopic ligation of the lymphatic trunk for refractory chylous ascites. J Pediatr Surg 2007; 42: 15-18.
    Google Scholar
  • 16 LeVeen HH, Wapnick S, Grosberg S, Kinney M. Further experience with peritoneo-venous shunt for ascites. Ann Surg 1976; 184: 574-581.
    CrossrefPubMedGoogle Scholar
  • 17 Merrigan BA, Winter DC, Sullivan GC. Chylothorax. Br J Surg 1997; 84: 15-20.
    CrossrefPubMedGoogle Scholar
  • 18 Mitsunaga T, Yoshida H, Iwai J. et al. Successful surgical treatment of two cases of congenital chylous ascites. J Pediatric Surg 2001; 36: 1717-1719.
    CrossrefPubMedGoogle Scholar
  • 19 Noel AA, Gloviczki P, Bender CF. et al. Treatment of symptomatic primary chylous disorders. J Vasc Surg 2001; 34: 785-791.
    CrossrefPubMedGoogle Scholar
  • 20 Oosterbosch L, Leloup A, Verstraeten P, Jordens P. Chylothorax and chylous asscites due to malignant lymphoma. Acta Clin Belg 1995; 50: 20-25.
    CrossrefPubMedGoogle Scholar
  • 21 Pabst III TS, McIntyre KE, Schilling JD, Hunter GC, Bernhard VM. Management of chyloperitoneum after abdominal aortic surgery. Am J Surg 1993; 166: 194-199.
    CrossrefPubMedGoogle Scholar
  • 22 Parsons SL, Watson SA, Steele RJC. Malignant ascites. Br J Surg 1996; 83: 6-14.
    CrossrefPubMedGoogle Scholar
  • 23 Picard JD. Chylothorax. In: Lymphatic circulation. Ed. Médicales Pierre Fabre; 1995: 78-86.
    Google Scholar
  • 24 Sanger R, Wilmshurst CC, Clyne CAC. Chylous ascites following aneurysm surgery. Eur J Vasc Surg 1991; 5: 689-692.
    CrossrefPubMedGoogle Scholar
  • 25 Skála J, Witte C, Bruna J, Case T, Finley P. Chyle leakage after blunt trauma. Lymphology 1992; 25: 62-68.
    PubMedGoogle Scholar
  • 26 Tasnádi G, Mattasi R, Fox U. Chyledema of a limb and chylothorax treated successfully with a Denver shunt. Lymphology 1998; 31 (suppl): 381-384.
    Google Scholar
  • 27 Tasnádi G. Generalized Lymphangiomatosis, Treatment with a Denver Shunt. In: Belov S, Loose DA, Weber J. (eds). Vascular Malformations. Reinbek: Einhorn Presse; 1989: 191-194.
    Google Scholar
  • 28 Yamauchi Sh. Lymphatic filariasis. In: Földi M, Casley-Smith JR. (eds). Lymphangiology. Stuttgart: Schattauer; 1983: 747-767.
    Google Scholar