Fístula quiloperitoneal en gestante a propósito de un caso: resumen / Quiloperitoneal fistula pregnant about a case: summary

El sistema linfático corresponde a una amplia red de capilares y vasos distribuidos por todo el organismo, que convergen a nivel del tórax a una estructura única mayor, el conducto torácico, el cual drena su contenido a la circulación venosa a nivel de la vena subclavia izquierda. La fístula quilosa se define como la perdida de linfa desde los vasos linfáticos, típicamente acumulado en la cavidad abdominal y/o torácica, ocasionalmente manifestada como una fístula externa. (120) El tratamiento conservador de la fístula quilosa está recomendado en la mayoría de los pacientes y va a estar determinado por las fístulas con gasto elevado que causan alteraciones fisiológicas tempranas, por lo que el tratamiento debe ser agresivo. Las fístulas quilosas de origen tumoral son de difícil manejo, el tratamiento es más exitoso si estas se presentan luego de un trauma o cirugía. Para mejorar la efectividad del tratamiento conservador, se ha sugerido asociar a las medidas antes señaladas el uso de somatostatina o sus análogos. El tratamiento quirúrgico es abordado cuando la terapia conservadora falla (40%).99 Se presenta el caso de femenina de 39 años, proveniente del Estado Nueva Esparta, sin antecedente patológicos conocidos, IV gesta, III para a quien se le realizo cesárea de emergencia a las 34 semanas por feto con poli hidramnios y al abordar cavidad abdominal hay la presencia de liquido de aspecto lechoso del cual obtienen 3000cc aprox., extraen el feto el cual estaba en condición estable, revisan cavidad abdominal sin evidenciar patología. Es egresada en condición estable, y consulta a los 7 días por aumento de volumen abdominal. En vista de esto es referida a nuestro centro donde se realizan diversos estudios como laboratorio que solo reportó anemia (Hb 10), marcadores tumorales (alfa feto proteína, Ca 19-9, CEA) negativos, pruebas especiales para descartar trastorno de coagulación resultaron negativos...

The lymphatic system represents a vast network of capillaries and vessels distributed throughout the body, which converge at the thoracic cavity to a largest single structure, the thoracic duct, which drains its contents into the venous circulation to the left subclavian vein. Chylous fistula is defined as a loss of lymph from the lymphatic vessels, typically accumulated in the abdominal cavity and/or cage, occasionally manifested as an external fistula. (120) Conservative treatment of chylous fistula is recommended in most patients and shall be determined by high output fistulas causing early physiological changes, so treatment should be aggressive. Tumoral chylous fistulas are difficult to manage; treatment is more successful if these appear after trauma or surgery. To improve the effectiveness of conservative treatment, it has been suggested to associate the use of somatostatin or its analogs with the above mentioned measures. Surgical treatment is addressed when conservative therapy fails (40%). We present a case of a 39 years-old female, from the state of Nueva Esparta - Venezuela, with no known medical history, GESTA IV, III who underwent emergency cesarean section at 34 weeks due to fetus with polyhydramnios. When approaching the abdominal cavity they found a milky fluid of which they obtained 3000cc approx.; they took out the fetus which was in stable condition and examined the abdominal cavity without evidence of any pathology, whatsoever. She was discharged in stable condition, and comes back to consult at 7 days after due to increased abdominal volume. For this reason, she was referred to our center where several studies are made, such as laboratory studies which only reported anemia (Hb 10), tumor markers (alpha fetoprotein, Ca 19-9, CEA) negative, special tests to rule out clotting disorder were negative; negative immunological profile (ANCA, ANA, AMA, AML), CT Scan of the chest-abdomen and pelvis which concluded...

Isolated Non-chylous Pleural Effusion in Two Neonates

Isolated pleural effusion, so called primary pleural effusion denotes a pleural effusion without documented etiology such as a cardiac, inflammatory, iatrogenic problem or fetal hydrops. Chromosomal anomaly such as Down syndrome may be associated with isolated pleural effusion. The content of the isolated pleural effusion is mostly chylous, and isolated non-chylous pleural effusion in neonate is rare. We experienced 2 cases of isolated non-chylous pleural effusion. They had neither cardiac problem nor other sign of hydrops fetalis. Imaging diagnosis was done by plain chest radiography and subsequent ultrasonogram. One of them was diagnosed to Down syndrome by karyotyping. They were fared well after diagnostic and therapeutic thoracentesis. We describe 2 cases of non-chylous pleural effusion and review a few English-language case reports of this entity.