Lymph is usually a clear fluid. However, in vessels leading off of the intestines it may appear milky white owing to the presence of absorbed fats. Chylous ascites, also known as chyloperitoneum, is a condition in which this fatty fluid collects in the peritoneal cavity, the area where the abdominal organs are contained. There may be a significant loss of proteins, antibodies and electrolytes. Chylous ascites is a rare complication caused mainly by surgical trauma or cancer involving the lymph nodes, according to researchers who developed a treatment algorythm at Saint Luc University Hospital in Belgium.
Low Fat Diet and TPN
In recommendations published in the July-September 2000 issue of "Acta Gastro-enterologica Belgica", the Belgian researchers state that a low fat diet is the first step in reducing the flow of lymph. Total parenteral nutrition, or TPN, may be added in order to bypass the bowel. TPN infuses nutrients directly into the large subclavian vein. To provide TPN, a peripherally inserted central catheter line is usually threaded through the arm, or a central line may be opened in the upper chest. The line will be inserted by a doctor or a specially trained and certified nurse, and catheter tip placement must be confirmed by X-ray prior to the start of TPN. Nutrients are then pumped into the bloodstream at scheduled intervals.
Medication
Octreotide, brand name Sandostatin, is listed in Drug Information Online as a synthetic form of the hormone somatostatin, which regulates growth hormones and decreases the body's release of chemicals involved in digestion. Although it is given to treat acromegaly, or giantism, and to treat some complications of pancreatitis, octreotide has been used to reduce the outflow of lymph fluid in persons with chylous ascites, as in a Japanese case study of a woman who developed the condition following liver transplant. According to the report published in the January 2008 issue of "Liver International", when a low fat diet and TPN failed to resolve lymph flow, results were rapidly obtained by administration of octreotide. The medication is given by shallow injection beneath the skin, using a tiny needle and syringe. Side effects may include stomach upset, gas, and bloating.
Surgical Procedures
Although leaking lymph may stop by itself, according to the Belgian scientists, the build-up of abdominal pressure can cause shortness of breath and affect kidney function. These considerations usually drive surgical treatment efforts. Paracentesis is the insertion of a long needle through the abdominal wall to drain large amounts of fluid. The patient is usually placed in a reclining position and given local anesthesia. The procedure may be guided by ultrasound.
When chylous ascites is a result of ruptured large lymph vessels, it may be necessary for surgeons to tie them off. Ligation is guided by radiological imaging.
Chylous fluid collection may also be surgically diverted into the large veins, where it is eliminated by the kidneys. Known as a peritoneovenous shunt, this procedure is seldom done to alleviate chylous ascites. In the care of cancer patients, improving the quality of life may outweigh any relatively small risk of spreading malignancy.
References
- "Liver International", Successful Management of Chylous Ascites after Living Donor Liver Transplantation with Somatostatin, January 2008
- Clinical Trials: Treatment With Octreotide in Patients With Lymphangioleiomyomatosis, April 29, 2010
- Drugs.com: Sandostatin
- "Acta Gastro-enterologica Belgica", Chylous Ascites: Diagnosis, Causes and Treatment, Laterre PF, et.al., July-September 2000
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