Successful management of chylous ascites using omental patch

ABSTRACT

To assess possible factors that may play a role in the etiology of chylous ascites formation, to determine the management of each type according to its causation, and to compare between the results of conservative and operative management. This is a prospective study conducted from 1990 to 2004 in the surgical department of Erbil, Iraq. A group of 46 patients with chylous ascites were subdivided into five subgroups according to the etiological factors. The initial assessment included age, sex, history of trauma and previous surgery, time between the trauma, if it was present, and the appearance of chylous ascites, and aspiration of ascetic fluid for chemical and bacteriological analysis. Further assessment included the use of ultrasonography, computerized axial tomography, and Magnetic resonance imaging [MRI]. There were 12 female and 34 male patients. Their ages ranged form one year to 63 years [mean age 37 years]. There was abdominal distention resulting from the accumulation of chyle in the peritoneal cavity in all five subgroups of patients. A definitive diagnosis was made by paracentesis and laparotomy. Thirty-eight patients [82.6%] underwent explorative laparotomy. The surgical success rate for trauma patients was about 93.7%, while it was very poor for malignant cases. The surgical technique in this study with the best results was overswing with omental patch. The results indicate that patients with chylous ascites caused by trauma to the abdomen who undergo surgery may have a success rate up to about 93.7% using omental patches, especially if preoperative resuscitation is done. The outcome of patients with malignant chylous ascites, however, was very poor. Conservative treatment was not satisfactory in any of these cases