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Case Reports
. 2024 May 30;2024(5):rjae357.
doi: 10.1093/jscr/rjae357. eCollection 2024 May.

Chylous ascites after associating liver partition and portal vein ligation for stage hepatectomy (ALPPS): overview and case report

Luz Estefanía González Gallegos  1   2 , Carlos Alberto Córdova Velázquez  1   2 , Oscar Chapa Azuela  2 , Irving Hugo Aguilar Preciado  2 , Carmen Judith Roca Vásquez  2 , Jorge Alberto Roldan García  2
Affiliations
Case Reports

Chylous ascites after associating liver partition and portal vein ligation for stage hepatectomy (ALPPS): overview and case report

Luz Estefanía González Gallegos et al. J Surg Case Rep. .

Abstract

Chylous ascites is an uncommon pathology with low incidence following hepato-pancreato-biliary surgery, there are no cases reported in the international literature following the associating liver partition and portal vein ligation for stage hepatectomy (ALPPS) procedure. It is caused by abnormal intraperitoneal accumulation of lymph fluid in the abdominal cavity secondary to obstruction or injury to the chyle cistern or its tributaries. We describe the case of a 49-year-old woman diagnosed with colon cancer and liver metastasis. ALPPS was performed, on a first and second stage, presenting a high drainage output as well as change in the characteristics of the drainage fluid. The diagnosis of chylous ascites was confirmed by finding triglyceride levels in the drainage fluid at 300 mg/dL. Medical treatment was started based on a hyper-protein diet and fat restriction, supplemented with medium-chain triglycerides and somatostatin analog, with fistula resolution. It can be managed with medical treatment.

Keywords: ALPPS; chylous ascites; colorectal liver metastasis; hepatectomy.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
CT scan images. (A) Coronal plane showing the tumor location involving segments 5, 6, 7 and 8. (B) Axial plane showing the relation to the inferior vena cava (IVC). (C) MRI showing a liver mass with peripheral and heterogeneous central enhancement. (D) Axial MRI (T1phase). Ao, aorta; S, spleen.
Figure 2
Figure 2
3D image reconstruction. (A) Right hemi-liver mass involving segments 5, 6, 7 and 8. The relation to the suprahepatic veins (HV), IVC and the PV is shown. (B) Future liver remnant (FLR) (Segments 2 and 3). SIVC, suprahepatic inferior vena cava; PV, portal vein; FLR, future liver remnant. (C) Liver volumetry. Coronal plane delimiting the transection line planned and the FLR. (D). Axial plane, showing the transection line planned and the FLR.
Figure 3
Figure 3
Intraoperative picture after the first stage (once completed the partial liver transection) and after the second stage. (A) Partial transection just to the right of the falciform ligament showing segments 2 and 3 (LR). (B) Intraoperative cholangiography. (C) Liver remnant (Segments 1, 2 and 3 at the end of the second stage). (D) Specimen after surgical removal showing the liver segments, and the transection plane (arrow).
Figure 4
Figure 4
Curve of peritoneal fluid triglyceride level of the patient.
See this image and copyright information in PMC

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