A Surgically Treated Case of Delayed Refractory Chyloperitoneum Developed after Gastrectomy against Advanced Gastric Cancer

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  • 手術治療が奏効した胃癌術後の遅発性難治性乳糜腹水の1例
  • 症例 手術治療が奏効した胃癌術後の遅発性難治性乳糜腹水の1例
  • ショウレイ シュジュツ チリョウ ガ ソウコウ シタ イガン ジュツゴ ノ チハツセイ ナンチセイニュウビフクスイ ノ 1レイ

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Abstract

A 74-year-old man underwent distal gastrectomy, D1 + with No.14v lymph node dissection, and Roux-en Y reconstruction for advanced gastric cancer with infiltration into the transverse mesocolon. When about 2 weeks had elapsed after initiation of adjuvant chemotherapy, he developed abdominal distention. Ascites was confirmed by a CT scan undertaken 3 months after the surgery. Abdominal paracentesis yielded a milky white ascites with remarkably elevated triglyceride level. Chylous ascites was thus diagnosed. Since conservative therapy was unsuccessful, he was referred to our hospital for further treatments 7 months after the surgery. Plain abdominal CT scan performed immediately after lymphangiography revealed leakage of lipiodol around the celiac artery and/or common hepatic artery. Upon laparotomy, we ligated and sutured the chylorrhea site to close the chylorrhea by using an absorbable tissue-reinforcing material and a physiological tissue adhesive.<BR>Prolonged chylorrhea for a long time extremely worsens the general condition of the patient. When we encounter refractory chylous ascites, it is important to perform surgical therapy without hesitation that can lead to a curative therapy.

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