scholarly journals Simultaneous presence of massive chyloperitoneum and chylothorax and its successful management

2018 ◽  
Vol 7 (3) ◽  
Author(s):  
Mukul Bhattarai ◽  
Tamer Hudali
Keyword(s):  
Bypass Graft ◽  
Chylous Ascites ◽  
Severe Malnutrition ◽  
Bypass Grafting ◽  
Medium Chain Triglycerides ◽  
Successful Management ◽  
Aortofemoral Bypass ◽  
Low Fat Diet ◽  
Life Threatening ◽  
Definitive Guideline

The incidence of massive chylous ascites and chylothorax after aortofemoral bypass grafting (AFBG) procedure is unknown. Leakage of chyle results in severe malnutrition and infection which can be life threatening. Because of the rarity of disease, the definitive guideline on management of such extensive accumulation of chyle is lacking. We present a case of a 68- year-old gentleman who developed large chylous ascites and chylous pleural effusions causing respiratory distress. His history was significant for aortofemoral bypass graft procedure 8 weeks prior to index presentation. He was successfully managed with chylous fluid drainage, judicious use of diuretics, adherence to a low-fat diet, and supplementation with medium-chain triglycerides.

scholarly journals Application of ultrasound-guided intranodal lymphangiography and embolisation in cancer patients with postoperative lymphatic leakage

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Xingwei Sun ◽  
Feng Zhou ◽  
Xuming Bai ◽  
Qiang Yuan ◽  
Mingqing Zhang ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Chylous Ascites ◽  
Pelvic Surgery ◽  
Ultrasound Guided ◽  
Technical Success Rate ◽  
Life Threatening ◽  
Low Incidence ◽  
Intranodal Lymphangiography

Abstract Background Traumatic lymphatic leakage is a rare but potentially life-threatening complication. The purpose of this study was to introduce ultrasound-guided intranodal lymphangiography and embolisation techniques for postoperative lymphatic leakage in patients with cancer. Methods From January 2018 through June 2020, seven cancer patients (three males, four females, aged 59–75 years [mean 67.57 ± 6.11 years]) developed lymphatic leakage after abdominal or pelvic surgery, with drainage volumes ranging from 550 to 1200 mL per day. The procedure and follow-up of ultrasound-guided intranodal lymphangiography and embolisation were recorded. This study retrospectively analysed the technical success rate, operative time, length of hospital stay, clinical efficacy, and complications. Results The operation was technically successful in all patients. Angiography revealed leakage, and embolisation was performed in all seven patients (7/7, 100%). The operative time of angiography and embolisation was 41 to 68 min, with an average time of 53.29 ± 10.27 min. The mean length of stay was 3.51 ± 1.13 days. Lymph node embolisation was clinically successful in five patients (5/7, 71.43%), who had a significant reduction in or disappearance of chylous ascites. The other two patients received surgical treatment 2 weeks later due to poor results after embolisation. All patients were followed for 2 weeks. No serious complications or only minor complications were found in all the patients. Conclusions Ultrasound-guided intranodal lymphangiography and embolisation were well tolerated by the patients, who experienced a low incidence of complications. Early intervention is recommended for cancer patients with postoperative lymphatic leakage.

scholarly journals Recurrent Chylous Ascites Leading to Transudative Chylothorax Due to Bi-Ventricular Heart Failure

2021 ◽  
Vol 9 ◽  
pp. 232470962110261
Author(s):  
Tuong Vi Cassandra Do ◽  
Justin Cozza ◽  
Shyam Ganti ◽  
Jayaramakrishna Depa
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Chronic Kidney Disease Stage ◽  
Bypass Graft ◽  
Chylous Ascites ◽  
Lower Extremities ◽  
Disease Status ◽  
Disease Stage ◽  
Chronic Obstructive

Chylothorax is a pleural effusion of >110 mg/dL of triglycerides with a milky appearance with transudative being rare. In this article, we present a case of transudative chylothorax with concurrent chylous ascites that is secondary to congestive heart failure (CHF). A 70-year-old male with CHF with ejection fraction of 10%, coronary artery disease status post coronary artery bypass graft, sleep apnea, chronic kidney disease stage 3, and chronic obstructive pulmonary disease presented with worsening abdominal distention, shortness of breath, and increased lower extremities edema. He denied any cough or fever but had orthopnea and paroxysmal nocturnal dyspnea. He requires monthly paracentesis with drainage of 5 to 9 L each time. On physical examination, he had crackles bilaterally with no wheezes or jugular venous distension. His cardiac examination was unremarkable. He did have abdominal distension with dullness to percussion and a positive fluid wave. There was +2 bilateral pitting edema of lower extremities. He had a diagnostic paracentesis where 9.2 L of cloudy milky fluid was drained and therapeutic thoracentesis where 1.1 L of milky fluid was drained. Pleural fluid for triglycerides was 280. His peritoneal fluid had triglycerides of 671 confirming chylous ascites. CHF can lead to chylous ascites due to the increased lymph production in the abdomen, which flows to the thoracic duct. Due to the stiffness at the lymphatic junction, there is high pressure for less flow. The diaphragm plays a role allowing the chylous ascites to be absorb into the thorax.

Axillary pullout syndrome: A novel approach to managing a devastating complication

Vascular ◽  
2021 ◽  
pp. 170853812110489
Author(s):  
Nathan W Kugler ◽  
Brian D Lewis ◽  
Michael Malinowski
Keyword(s):  
Stent Graft ◽  
Effective Means ◽  
Bypass Graft ◽  
Hybrid Approach ◽  
Inpatient Rehabilitation ◽  
Anastomotic Dehiscence ◽  
Open Approach ◽  
Novel Approach ◽  
Life Threatening ◽  
History Of

Objectives Axillary pullout syndrome is a complex, potentially fatal complication following axillary-femoral bypass graft creation. The re-operative nature, in addition to ongoing hemorrhage, makes for a complicated and potentially morbid repair. Methods We present the case of a 57-year-old man with history of a previous left axillary-femoral-femoral bypass who presented with acute limb-threatening ischemia as a result of bypass thrombosis managed with a right axillary-femoral bypass for limb salvage. His postoperative course was complicated by an axillary anastomotic dehiscence while recovering in inpatient rehabilitation resulting in acute, life-threatening hemorrhage. He was managed utilizing a novel hybrid approach in which a retrograde stent graft was initially placed across the anastomotic dehiscence for control of hemorrhage. He then underwent exploration, decompression, and interposition graft repair utilizing the newly placed stent graft to reinforce the redo axillary anastomosis. Results and Conclusion Compared with a traditional operative approach, the hybrid endovascular and open approach limited ongoing hemorrhage while providing a more stable platform for repair and graft revascularization. A hybrid approach to the management of axillary pullout syndrome provides a safe, effective means to the management of axillary anastomotic dehiscence while minimizing the morbidity of ongoing hemorrhage.

scholarly journals Successful Off-Label Use of an Iliac Branch Device to Rescue an Occluded Aortofemoral Bypass Graft

2018 ◽  
Vol 26 (1) ◽  
pp. 128-132 ◽  
Author(s):  
Mario D’Oria ◽  
Marco Pipitone ◽  
Francesco Riccitelli ◽  
Davide Mastrorilli ◽  
Cristiano Calvagna ◽  
...  
Keyword(s):  
Bypass Graft ◽  
Limb Ischemia ◽  
Aortofemoral Bypass ◽  
Off Label ◽  
Alternative Approach ◽  
Aortic Thrombus ◽  
Endovascular Device ◽  
Completion Angiography ◽  
Antegrade Catheterization

Purpose: To report an alternative approach for rescue of an occluded aortofemoral bypass using the Gore Excluder Iliac Branch Endoprosthesis (IBE). Case Report: A 52-year-old man presented with acute right limb ischemia because of displaced and occluded iliac stents and was treated with aortofemoral bypass. On the third postoperative day, there was early bypass failure due to distal embolization from aortic thrombus. After fluoroscopy-guided balloon thrombectomy of the bypass, an endovascular bailout strategy was used. The Gore Excluder IBE was deployed below the renal arteries (with the external iliac limb opening in the surgical prosthesis and the gate opening within the aortic lumen). After antegrade catheterization of the gate, a Gore Viabahn endoprosthesis was inserted as the bridging endograft and deployed so that it landed just above the preimplanted aortoiliac kissing stents without overlapping them. Completion angiography showed technical success without complications; results were sustained at 1-year follow-up. Conclusion: The Gore Excluder IBE may represent a versatile solution for the rescue of complex cases when open surgery would be associated with a considerable risk. This off-label application of a well-recognized endovascular device is safe and feasible and may prove useful as a valuable alternative in properly selected patients.

scholarly journals Successful Treatment of Clostridium difficile Bacteremia with Aortic Mycotic Aneurysm in a Patient with Prior Endovascular Aortic Aneurysm Repair

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Kairav Shah ◽  
Rebecca Brauch ◽  
Kartikeya Cherabuddi
Keyword(s):  
Clostridium Difficile ◽  
Aortic Aneurysm ◽  
Mycotic Aneurysm ◽  
Bypass Graft ◽  
Endovascular Aortic Aneurysm Repair ◽  
Life Threatening ◽  
History Of ◽  
Gastrointestinal Colonization ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

The clinical spectrum of Clostridium difficile infection can range from benign gastrointestinal colonization to mild diarrhea and life threatening conditions such as pseudomembranous colitis and toxic megacolon. Extraintestinal manifestations of C. difficile are rare. Here, we report a patient with a history of an endovascular aortic aneurysm repair (EVAR) presenting with an endovascular leak complicated by C. difficile bacteremia and a mycotic aneurysm. He was successfully treated with an explant of the EVAR, an aorto-left renal bypass, and aorto-bi-iliac bypass graft placement along with a six-week duration of intravenous vancomycin and oral metronidazole.

Gas-chromatographic/mass spectrometric detection of 3-hydroxy-3-methylglutaryl-CoA lyase deficiency in double first cousins.

1982 ◽  
Vol 28 (1) ◽  
pp. 137-140 ◽  
Author(s):  
E J Norman ◽  
M D Denton ◽  
H K Berry
Keyword(s):  
Gas Chromatography Mass Spectrometry ◽  
Fat Intake ◽  
Acid Excretion ◽  
Reye's Syndrome ◽  
Low Fat Diet ◽  
Low Protein ◽  
Urinary Organic Acids ◽  
Life Threatening ◽  
Leucine Catabolism ◽  
Chromatographic Mass

Abstract Gas chromatography/mass spectrometry was used for the detection of 3-hydroxy-3-methylglutaryl-CoA lyase (EC 4.1.3.4) deficiency in double first cousins. This enzyme is in the last step of leucine catabolism and is also involved in ketogenesis. Quantitation of urinary organic acids as their cyclohexyl esters demonstrated increased concentrations of 3-hydroxy-3-methylglutaric acid, 3-methylglutaconic acid, 3-methylglutaric acid, and 3-hydroxyisovaleric acid. The procedure is more rapid, sensitive, and specific than previously reported gas-chromatographic methods for acid quantitation. The affected children initially presented with symptoms similar to Reye's syndrome; the acids were quantitated during periods of altered intake of protein and fat. Both leucine and fat intake contributed to increased acid excretion. These studies suggest that life-threatening episodes of hypoglycemia are best prevented with a low-protein, low-fat diet.

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