PDF(Pubmed)
Abstract：
BACKGROUND Chyle leakage with chylous ascites is a rare complication of abdominal surgery, and few cases have been reported following cholecystectomy. This report is of a 64-year-old man with chyle leak following laparoscopic cholecystectomy and describes the diagnosis and approach to treatment. Immediate diagnosis, although challenging, remains imperative. Frequently, patients manifest nonspecific symptoms, such as abdominal discomfort or nausea. They can also exhibit milky discharge from drains and wounds. Abdominal fluid analysis is fundamental for diagnosis. The existence of elevated triglyceride levels in peritoneal fluid is indicative of chyle leakage. CASE REPORT We present a case report of a 64-year-old man with chyle leakage after laparoscopic cholecystectomy for acute cholecystitis, on postoperative day 2. A milky-white fluid was drained, and diagnosis was confirmed with elevated triglycerides upon fluid analysis. Chyle leakage decreased gradually until complete resolution at postoperative day 7, after dietary modifications and the closed-suction silicone drain was removed. The patient was symptom-free at a 2-month follow-up. CONCLUSIONS Although chyle leakage is a rare postoperative complication of laparoscopic cholecystectomy, early diagnosis and rapid multidisciplinary management are required. It is vital to consider this diagnosis even if the course of laparoscopic cholecystectomy was uncomplicated and with no anatomical variation. Thus, a closed-suction silicone drain and close monitoring of output is essential for early diagnosis. The dietary modification constitutes a cornerstone in the management of chyle leakage, and a surgical approach should be preserved for patients for whom the conservative approach fails or who have large volumes of chyle.
摘要：
背景技术乳糜腹水是一种罕见的腹部手术并发症,胆囊切除术后很少有病例报道。该报告是关于一名64岁的男子在腹腔镜胆囊切除术后发生乳糜漏的报告，并描述了诊断和治疗方法。立即诊断,虽然具有挑战性，仍然势在必行。经常,患者表现出非特异性症状，如腹部不适或恶心。它们还可以表现出来自排水沟和伤口的乳状排出物。腹液分析是诊断的基础。腹膜液中甘油三酯水平升高的存在表明乳糜渗漏。案例报告我们提供了一例64岁男性腹腔镜胆囊切除术后发生乳糜漏的病例报告，术后第2天。排出了乳白色的液体，并且在流体分析中通过升高的甘油三酯证实了诊断。在饮食调整和去除闭式硅胶引流后，乳糜渗漏逐渐减少，直到术后第7天完全消退。患者在2个月的随访中无症状。结论尽管乳糜漏是腹腔镜胆囊切除术的一种罕见的术后并发症,需要早期诊断和快速多学科管理.即使腹腔镜胆囊切除术的过程简单且没有解剖变异，也必须考虑这种诊断。因此，闭式吸式硅胶引流和密切监测输出对早期诊断至关重要。饮食调整构成了乳糜渗漏管理的基石，对于保守方法失败或有大量乳糜的患者，应保留手术方法。
