Abstract
Chylous ascites is a rare complication following pancreaticoduodenectomy. We report on a case of chylous ascites following pancreaticoduodenectomy in a 76-year-old patient diagnosed with pancreatic cancer. There are various known conservative management strategies, including dietary measures or total parenteral nutrition. Unfortunately, conservative treatment—with total parenteral nutrition and fasting over a period of 4 weeks—was not successful in the present case. The daily output volume of chylous ascites was up to 2500 ml/day. Based on clinical experiences with successfully treated lymphocutaneous fistulas, low-dose radiotherapy was initiated. External beam radiotherapy comprising a total dose of 8.0 Gy to the paraaortic lymph node region was administered in daily single fractions of 1.0 Gy (five fractions/week). Throughout the course of external beam radiotherapy, the secretion of abdominal ascites rapidly decreased, resulting in complete resolution after 2 weeks. There was no clinical evidence of chylous ascites on follow-up. As a result of this experience, we believe that external beam radiotherapy should be considered as an alternative therapy in refractory cases of chylous ascites.
Zusammenfassung
Das Chyloperitoneum ist eine seltene Komplikation nach Pankreatikoduodenektomie. Wir berichten über einen 76-jährigen Patienten mit Chyloperitoneum nach Resektion eines Pankreaskarzinoms. Die konservativen Therapiestrategien, wie beispielsweise diätetische Maßnahmen oder totale parenterale Ernährung, waren im vorliegenden Fall über einen Zeitraum von 4 Wochen nicht erfolgreich. Es bestand eine persistierende Sekretion von Chylaszites von bis zu 2500 ml/Tag. Basierend auf den klinischen Erfahrungen bei erfolgreich behandelten lymphokutanen Fisteln, wurde eine perkutane Radiotherapie eingeleitet. Die Bestrahlung des paraaortalen Lymphabflusses über ventrodorsale Gegenfelder wurde bis zu einer Gesamtdosis von 8,0 Gy in 1,0 Gy Einzeldosis (5 Fraktionen/Woche) durchgeführt. Bereits im Verlauf der Behandlung zeigte sich die Sekretion von Chylaszites deutlich rückläufig und sistierte nach 2 Wochen vollständig. Aufgrund dieser klinischen Erfahrung sind wir der Auffassung, dass eine perkutane Bestrahlung in therapierefraktären Fällen von Chyloperitoneum als Therapieoption in Betracht gezogen werden sollte.
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S. Corradini, S. Liebig, O.M. Niemoeller, F. Zwicker, and W. Lamadé state that there are no conflicts of interest. Informed consent was obtained from all patients included in studies. Consent was obtained from all patients identifiable from images or other information within the manuscript. In the case of underage patients, consent was obtained from a parent or legal guardian.
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Felix Zwicker and Wolfram Lamadécontributed equally to this work.
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Corradini, S., Liebig, S., Niemoeller, O. et al. Successful radiation treatment of chylous ascites following pancreaticoduodenectomy. Strahlenther Onkol 191, 448–452 (2015). https://doi.org/10.1007/s00066-014-0805-z
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DOI: https://doi.org/10.1007/s00066-014-0805-z