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Case Reports
. 2019 Jan 24;2019(1):rjy364.
doi: 10.1093/jscr/rjy364. eCollection 2019 Jan.

Chylothorax secondary to a pleuroperitoneal communication and chylous ascites after pancreatic resection

Kazuki Hayashi  1 , Jun Hanaoka  1 , Yasuhiko Ohshio  1 , Tomoyuki Igarashi  1
Affiliations
Case Reports

Chylothorax secondary to a pleuroperitoneal communication and chylous ascites after pancreatic resection

Kazuki Hayashi et al. J Surg Case Rep. .

Abstract

To the best of our knowledge, there have been no previous reports of chylothorax developing after pancreatectomy, although chylous ascites can occur. In patients with a pleuroperitoneal communication, ascitic fluid can flow into the thoracic cavity through a small hole in the diaphragm. A 70-year-old woman underwent total pancreatectomy and was referred to our department for treatment of right chylothorax after removal of her abdominal drainage tubes. An occult pleuroperitoneal communication was detected, and the portion of the diaphragm containing a diaphragmatic fistula was resected using a surgical stapler. After surgery, the chylothorax resolved, but chylous ascites developed. We speculated that this was a rare case of chylous ascites that flowed into the thoracic cavity through a diaphragmatic fistula after a pancreatic resection. When a patient develops chylothorax after an abdominal operation, the combination of a pleuroperitoneal communication and chylous ascites must be considered.

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Figures

Figure 1:
Figure 1:
Chest radiograph on postoperative Day 12 after pancreatectomy A chest radiograph showing a right-sided sub-massive pleural effusion.
Figure 2:
Figure 2:
Operative findings during thoracic surgery. (A) Operative findings show a diaphragmatic fistula (arrow). (B) The fistula is closed with a surgical stapler. (C) The resected diaphragm shows a pleuroperitoneal communication. (Fibrosis was observed; however, no other pathological abnormality was identified in the excised diaphragmatic tissue.)
Figure 3:
Figure 3:
Abdominal computed tomography (CT) after thoracic surgery. Abdominal CT after thoracic surgery shows sub-massive ascites (arrows).
Figure 4:
Figure 4:
Clinical course and triglyceride levels of ascites and pleural effusion (A) After resuming oral intake, the amount of ascitic fluid increased. (B) After removal of the abdominal drainage tubes, a pleural effusion appeared. (C) The patient was treated with a low-fat diet followed by discontinuation of oral intake and administration of octreotide. More than 500 mL of pleural effusion was drained daily. (D) Following thoracic surgery, the patient developed abdominal ascites. (a) The triglyceride level in the pleural effusion is 536 mg/dL. (b) The triglyceride level in the pleural effusion is 12 mg/dL. (c) The triglyceride level in the ascitic fluid is 124 mg/dL.
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