P2537 - Unexpected Complication: Chylous Ascites Following Abdominal Aortic Aneurysm Repair

Kanza Shamim, MD¹, Muhammad Janisar, MD², Shoaib Rashid, MD³, Khawaja Ahmed Salman Zaki, MD³, Shadab Ahmed, MD^3
1Nassau University Medical Center, Merrick, NY; ²Mount Auburn Hospital, Harvard Medical School, Cambridge, MA; ³Nassau University Medical Center, East Meadow, NY

Introduction: Chylous ascites is the collection of triglyceride rich creamy fluid loaded with triglycerides in abdominal cavity. ¹ This lipid-rich lymphatic accumulation in the peritoneal cavity may result from inadvertent injury to the lymphatic channels during surgical procedures, leading to the leakage of chyle. Chylous ascites has been largely reported with advancements of more intense surgeries like abdominal aortic resection, retroperitoneal lymphadenectomy, pancreatoduodenectomy, vagotomy, warren shunt, Nissen fundoplication, Radical nephrectomy and Peritoneal dialysis catheter placement². Chylous ascites is an uncommon but significant complication after abdominal aortic aneurysm (AAA) repair.

Case Description/Methods: 66-year-old male with severe abdominal pain radiating to his back was admitted. US KUB showed leaking large Abdominal Aortic Aneurysm (AAA). Patient underwent emergent AAA repair. The patient’s post operative course was complicated by massive ascites which was managed by diuretics without any resolution. On 9th Post op day patient developed nausea, vomiting, abdominal distention, and dyspnea. Patient underwent diagnostic and therapeutic ascitic tap with 2-liter rich milky brown fluid. Ascitic Fluid Analysis showed triglycerides of 982 mg/dl and albumin of 2020 g/dl which was consistent with Chylous ascites. The patient was managed conservatively by NPO and TPN and responded well to conservative approach and his abdominal distension markedly improved.

Discussion: Chylous Ascites (CA)is the pathologic collection of lymphatic fluid rich in triglycerides. The mechanisms of CA include exudation via mega lymphatics of bowel. Post operative CA is due to operative trauma to cisterna chili in retroperitoneal area¹⁻³.CA presents as painless abdominal distention, dyspnea, wasting and eventually death. Paracentesis is primary to ambit a diagnosis and triglyceride level above 110 mg/dl highly implicative of CA⁴, ⁵. Ultrasound and CT are common imaging techniques⁶. Nonoperative treatment include nutrition improvement and dietary modification with low fat. The main objectives of surgical management with laparoscopic or open laparotomy are to identify leaking lymphatics and to clip or suture. In case of refractory CA peritoneovenous shunting may be helpful⁵.


Disclosures:


Kanza Shamim, MD¹, Muhammad Janisar, MD², Shoaib Rashid, MD³, Khawaja Ahmed Salman Zaki, MD³, Shadab Ahmed, MD³. P2537 - Unexpected Complication: Chylous Ascites Following Abdominal Aortic Aneurysm Repair, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.