A case report of chylous ascites after cardiac surgery

Abstract

Background: Chylous ascites (CA), an emulsion rich in triglycerides, is a rare type of ascites, especially after cardiac surgery. Also, there are few reports of the occurrence of CA after mitral valve replacement, aortic valve replacement, tricuspid valvuloplasty, and coronary artery bypass grafting.

Case presentation: We report the case of a 53-year-old man who underwent surgery for a diagnosis of mitral incompetence, aortic incompetence, tricuspid incompetence, and coronary atherosclerotic heart disease. Fifteen days after surgery, 3000 mL of milky-yellow ascites appeared in the abdominal cavity, diagnosed as CA by laboratory examination. The ascites gradually disappeared after being drained, and the patients improved. The curative was objective, but the exact cause is not clear.

Conclusion: Although CA is rare, it may occur during the surgical intervention in cardiac surgery.

Keywords

Cardiac intensive care unit / Cardiac valve replacement / Case report / Chylous ascites / Coronary artery bypass graft / Department of cardiac surgery

Conflict of interest statement

The authors declare no conflict of interest.

Author contributions

Yuan S, Xie P, and Li P wrote the main article. Liu X prepared the figures. All authors have read and approved the final article.

Funding

The study was supported by the general program of the National Natural Science Foundation of China (82170435).

Ethical approval of studies and informed consent

This study was approved by the University of Hong Kong-Shenzhen Hospital Ethics Committee (no. [2022] 094, April 25, 2022) and written informed consent was obtained from the patient. This article has the consent of the patient for the use of his data and for the publication of the data that appear in the article. All methods were carried out following the relevant guidelines and conformed to the declaration of Helsinki.

Acknowledgments

We would like to express our heartfelt thanks to all people who helped us in the process of writing this paper.

References

[1] Dababneh Y, Mousa OY. Chylous Ascites. In: StatPearls. Treasure Island (FL): StatPearls Publishing. Accessed May 2, 2022. https://www.ncbi.nlm.nih.gov/books/NBK557406/

[2] Santos E, Moussa AM. Chylous ascites and lymphoceles: evaluation and interventions. Semin Intervent Radiol. 2020; 37(3):274-284. doi:10.1055/s-0040-1713445

[3] Bhardwaj R, Vaziri H, Gautam A, Ballesteros E, Karimeddini D, Wu GY. Chylous ascites: a review of pathogenesis, diagnosis and treatment. J Clin Transl Hepatol. 2018; 6(1):105-113. doi:10.14218/JCTH.2017.00035

[4] Thaler MA, Bietenbeck A, Schulz C, Luppa PB. Establishment of triglyceride cut-off values to detect chylous ascites and pleural effusions. Clin Biochem. 2017; 50(3):134-138. doi:10.1016/j.clinbiochem.2016.10.008

[5] Adler E, Bloyd C, Wlodarczyk S. Chylous ascites. J Gen Intern Med. 2020; 35(5):1586-1587. doi:10.1007/s11606-019-05532-3

[6] Oliver G, Kipnis J, Randolph GJ, Harvey NL. The lymphatic vasculature in the 21^st century: novel functional roles in homeostasis and disease. Cell. 2020; 182(2):270-296. doi:10.1016/j.cell.2020.06.039

[7] Steinemann DC, Dindo D, Clavien PA, Nocito A. Atraumatic chylous ascites: systematic review on symptoms and causes. J Am Coll Surg. 2011; 212(5):899-905.e9054. doi:10.1016/j.jamcollsurg.2011.01.010

[8] Lizaola B, Bonder A, Trivedi HD, Tapper EB, Cardenas A. Review article: the diagnostic approach and current management of chylous ascites. Aliment Pharmacol Ther. 2017; 46(9):816-824. doi:10.1111/apt.14284

[9] Browse NL, Wilson NM, Russo F, al-Hassan H, Allen DR. Aetiology and treatment of chylous ascites. Br J Surg. 1992; 79(11):1145-1150. doi:10.1002/bjs.1800791110

[10] Scaletta G, Quagliozzi L, Cianci S, et al. Management of postoperative chylous ascites after surgery for ovarian cancer: a single-institution experience. Updates Surg. 2019; 71(4):729-734. doi:10.1007/s13304-019-00656-x

[11] Chen J, Lin RK, Hassanein T. Use of orlistat (xenical) to treat chylous ascites. J Clin Gastroenterol. 2005; 39(9):831-833. doi:10.1097/01.mcg.0000177232.51888.2e

[12] Ghimire S, Shah H, Paudel S, Yang TJ, Khan HM. Chylous ascites and pleural effusion treated with intravenous octreotide. Cureus. 2020; 12(6):e8669. doi:10.7759/cureus.8669

[13] Ohkura Y, Ueno M, Iizuka T, Udagawa H. Effectiveness of etilefrine regimen for chylothorax after esophagectomy with thoracic duct resection. Esophagus. 2018; 15(1):33-38. doi:10.1007/s10388-017-0592-6

[14] Fatah A, Audiyanto T. Refractory Chylous ascites with chylothorax and an umbilical hernia in a patient ineligible for a transjugular intrahepatic portosystemic shunt. Am J Case Rep. 2020; 21:e925026. doi:10.12659/AJCR.925026

[15] Yannes M, Shin D, McCluskey K, Varma R, Santos E. Comparative analysis of intranodal lymphangiography with percutaneous intervention for postsurgical chylous effusions. J Vasc Interv Radiol. 2017; 28(5):704-711. doi:10.1016/j.jvir.2016.12.1209

[16] Kim PH, Tsauo J, Shin JH. Lymphangiography with or without embolization for the treatment of postoperative chylous ascites. Ann Vasc Surg. 2020; 68:351-360. doi:10.1016/j.avsg.2020.04.063