難治性乳糜腹水に対し腹腔鏡下フィブリン糊散布による漏出孔閉鎖を行った一例

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  • Fibrin Adhesive Spray Occlusion using a Laparoscope for Intractable Chylous Ascites: Case Report

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Introduction: Chylous ascites due to lymphorrhea following a para-aortic lymphadenectomy is a rare complication. Chylous ascites usually resolves spontaneously; however, some cases of intractable chylous ascites persist despite fasting therapy or a low fat diet. We report a case of intractable chylous ascites that was resolved via laparoscopic surgery.<br>Case: A patient with uterine corpus cancer underwent a modified radical hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and para-aortic lymphadenectomy. Although the surgical drainage was significant postoperatively, the patient's postoperative status was good. Therefore, she was discharged two weeks after the surgery. However, one week later, she presented at the hospital with the chief complaint of abdominal distension. An ultrasound examination revealed a large amount of ascites. Chylous ascites was determined with a paracentesis. The ascites was temporarily controlled by octoreotide acetate administration for nine days; however, she experienced a recurrence of chylous ascites two weeks later. Therefore we decided upon a laparoscopic procedure. We discovered leakage between the duodenum and the left renal vein. We could not separate and ligate the leaking duct. Therefore we selected to apply fibrin adhesive spray occlusion to the leakage area. Subsequently, the ascites gradually resolved. No recurrence occurred by 12 months after the surgery.<br>Conclusion: If chylous ascites does not resolve spontaneously, laparoscopic surgery may prove effective for resolution of the ascites.

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