PDF(Pubmed)
Abstract：
One week after an elective laparoscopic cholecystectomy at an outside hospital, a 56-year-old male presented to the emergency department with right-sided abdominal pain. Computerized tomography (CT) revealed a complex fluid collection in the gallbladder fossa. The patient underwent drain placement and received broad-spectrum intravenous antibiotics. Drain output was suspicious for a chyle leak, which was confirmed by elevated fluid triglyceride levels. Magnetic resonance cholangiopancreatography (MRCP) and hepatobiliary iminodiacetic acid (HIDA) analysis showed evidence of a concurrent bile leak. After starting a low fat, high protein diet and octreotide, a common bile duct sphincterotomy with plastic stent placement was performed. The patient\'s symptoms and drain output proceeded to improve. The cause of the chyle leak is unclear. However, with consideration of the patient\'s concurrent bile leak, an injury to the right major lymphatic drainage pathway and adjacent bile duct is suspected.
摘要：
在外部医院进行选择性腹腔镜胆囊切除术后一周，一名56岁男性因右侧腹痛出现在急诊科。计算机断层扫描（CT）显示胆囊窝中存在复杂的液体收集。患者接受引流并接受广谱静脉抗生素治疗。排水输出怀疑是乳酪泄漏，液体甘油三酯水平升高证实了这一点。磁共振胰胆管造影（MRCP）和肝胆亚氨基二乙酸（HIDA）分析显示有并发胆漏的证据。在开始低脂肪之后，高蛋白饮食和奥曲肽，进行了胆总管括约肌切开术，并放置了塑料支架。患者的症状和排水输出继续改善。乳酪泄漏的原因尚不清楚。然而,考虑到病人并发的胆漏，怀疑右侧主要淋巴引流途径和邻近胆管损伤。
