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Chylous ascites in the setting of internal hernia: a reassuring sign

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Abstract

Background

Chylous ascites is often reported in cases with lymphatic obstruction or after lymphatic injuries such as intraabdominal malignancies or lymphadenectomies. However, chylous ascites is also frequently encountered in operations for internal hernias. We sought to characterize the frequency and conditions when chylous ascites is encountered in general surgery patients.

Methods

Data from patients who underwent operations for CPT codes related to open and laparoscopic abdominal and gastrointestinal surgery in our tertiary hospital from 2010 to 2019 were reviewed. Patients with the postoperative diagnosis of internal hernia were identified and categorized into three groups: Internal Hernia with chylous ascites, non-chylous ascites, and no ascites. Demographics, prior surgical history, CT findings, source of internal hernia, open or laparoscopic surgery, and preoperative labs were recorded and compared.

Results

Fifty-six patients were found to have internal hernias and were included in our study. 80.3% were female and 86% had a previous Roux-en-Y gastric bypass procedure (RYGBP). Laparoscopy was the main approach for all groups. Ascites was present in 46% of the cases. Specifically, chylous ascites was observed in 27% of the total operations and was exclusively (100%) found in patients with gastric-bypass history. Furthermore, it was more commonly associated with Petersen’s defect (p < 0.001), while the non-chylous fluid group was associated with herniation through the mesenteric defect (p < 0.001).

Conclusions

Chylous ascites is a common finding during internal hernia operations. Unlike other more morbid conditions, identification of chylous ascites during an internal hernia operation appears innocuous. However, in the context of a patient with a history of RYGBP, the presence of chylous fluid signifies the associated small bowel obstruction is likely related to an internal hernia through a patent Petersen’s defect.

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Authors and Affiliations

  1. Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 122, Indianapolis, IN, 46202, USA

    Dimitrios I. Athanasiadis, Rosalie A. Carr, Don Selzer, Nicole Kissane Lee, Ambar Banerjee, Dimitrios Stefanidis & Jennifer N. Choi

  2. Indiana University School of Medicine, Indianapolis, IN, USA

    Robert Painter

Authors
  1. Dimitrios I. Athanasiadis
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  2. Rosalie A. Carr
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  4. Don Selzer
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Correspondence to Jennifer N. Choi.

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Disclosure

Dr. Don Selzer is a consultant for Cook Biotech and has received research support by Bard and Dr. Stefanidis has received an institutional research grant by ExplORer surgical. However, none of the research in the present report was funded by the above. Dr. Dimitrios I. Athanasiadis, Dr. Rosalie A. Carr, Dr. Rob Painter, Dr. Nicole K. Lee, Dr. Banerjee, and Dr. Jennifer N. Choi have no conflicts of interest or financial ties to disclose.

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Athanasiadis, D.I., Carr, R.A., Painter, R. et al. Chylous ascites in the setting of internal hernia: a reassuring sign. Surg Endosc 36, 2570–2573 (2022). https://doi.org/10.1007/s00464-021-08545-4

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  • DOI: https://doi.org/10.1007/s00464-021-08545-4

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