Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지

선천성 간섬유화증에서 비-신장 문합수술 후에 발생한 소아의 유미성 복수증 1례

A case of post-operative chylous ascites after a splenorenal shunt operation in a child with congenital hepatic fibrosis

  • 윤종형 (서울대학교 의과대학 소아과학교실) ;
  • 양혜란 (서울대학교 의과대학 소아과학교실) ;
  • 고재성 (서울대학교 의과대학 소아과학교실) ;
  • 서정기 (서울대학교 의과대학 소아과학교실)
  • Yoon, Jong Hyung (Department of Pediatrics, College of Medicine, Seoul National University) ;
  • Yang, Hye Ran (Department of Pediatrics, College of Medicine, Seoul National University) ;
  • Ko, Jae Sung (Department of Pediatrics, College of Medicine, Seoul National University) ;
  • Seo, Jeong Kee (Department of Pediatrics, College of Medicine, Seoul National University)
  • 투고 : 2006.06.23
  • 심사 : 2006.08.11
  • 발행 : 2006.10.15
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초록

유미성 복수는 복강이나 후복강의 림프순환계에 이상이 발생하는 질환이나 각종 원인에 의해서 발생하는 드문 질환으로서, 대개 혈장 내 triglyceride보다 2-8배 이상의 높은 복수 내 triglyceride의 함량을 보이는 경우 진단이 가능하다. 유미성 복수는 여러 가지 원인에 의해서 발생할 수 있지만, 수술 후 부작용으로서 복강이나 후복강 및 종격동의 수술 후 발생하는 경우가 드물게 있다. 저자들은 선천성 간섬유화증을 가진 소아 환자에서 비-신장 단락수술(Warren 단락술) 후에 발생하여 금식 및 총정맥영양에 이어 저지방식이를 시행한 후 호전된 유미성 복수증 1례를 경험하였기에 문헌고찰과 함께 이를 보고하는 바이다.

Chylous ascites is a rare condition caused by various diseases and conditions that interfere with the abdominal or retroperitoneal lymphatics, and uncommonly it can manifest as a post-operative complication after abdominal, retroperitoneal or mediastinal surgery. Chylous ascites can be diagnosed by a high triglyceride content in ascites. The authors experienced a 5-year-old girl with congenital hepatic fibrosis who presented with chylous ascites after a splenorenal shunt operation, who was successfully managed by fasting and total parenteral nutrition, followed by a lipid-free diet with medium chain triglyceride supplementation. Here, the authors report this case of post-operative chylous ascites after a splenorenal shunt (Warren shunt) operation with a review of the pertinent literature.

키워드

참고문헌

  1. Browse NL, Wilson NM, Russo F, al-Hassan H, Allen DR. Aetiology and treatment of chylous ascites. Br J Surg 1992;79:1145-50 https://doi.org/10.1002/bjs.1800791110
  2. Shapiro AM, Bain VG, Sigalet DL, Kneteman NM. Rapid resolution of chylous ascites after liver transplantation using somatostatin analog and total parenteral nutrition. Transplantation 1996;61:1410-1
  3. Ablan CJ, Littooy FN, Freeark RJ. Postoperative chylous ascites: diagnosis and treatment. A series report and literature review. Arch Surg 1990;125:270-3 https://doi.org/10.1001/archsurg.1990.01410140148027
  4. Leibovitch I, Mor Y, Golomb J, Ramon J. The diagnosis and management of postoperative chylous ascites. J Urol 2002;167:449-57 https://doi.org/10.1016/S0022-5347(01)69064-5
  5. Jayabose S, Kogan S, Berezin S, Slim M, San Filippo JA, Godine L, et al. Combined occurrence of chyloperitoneum and chylothorax after surgery and chemotherapy for Wilms' tumor. Cancer 1989;64:1790-5 https://doi.org/10.1002/1097-0142(19891101)64:9<1790::AID-CNCR2820640905>3.0.CO;2-V
  6. Pabst TS 3rd, McIntyre KE Jr, Schilling JD, Hunter GC, Bernhard VM. Management of chyloperitoneum after abdominal aortic surgery. Am J Surg 1993;166:194-8 https://doi.org/10.1016/S0002-9610(05)81055-4
  7. Baniel J, Foster RS, Rowland RG, Bihrle R, Donohue JP. Management of chylous ascites after retroperitoneal lymph node dissection for testicular cancer. J Urol 1993;150: 1422-4 https://doi.org/10.1016/S0022-5347(17)35797-X
  8. Chun SH, Lee YS, Kim JJ, Shin DH. A case of chylous ascites. J Korean Pediatr Soc 1982;25:1280-4
  9. Allen W, Parrott TS, Saripkin L, Allan C. Chylous ascites following retroperitoneal lymphadenectomy for granulosa cell tumor of the testis. J Urol 1986;135:797-8 https://doi.org/10.1016/S0022-5347(17)45858-7
  10. Hwang JB, Choi SO, Park WH. Resolution of refractory chylous ascites after Kasai portoenterostomy using octreotide. J Pediatr Surg 2004;39:1806-7 https://doi.org/10.1016/j.jpedsurg.2004.08.009
  11. Park JM, Kim YW. A case of child chylous ascites. J Korean Pediatr Soc 1963;6:115
  12. Choi GJ, Park CM. A case report of chylous ascites. J Korean Pediatr Soc 1977;20:396-8
  13. Park KJ, Byun SH, Hwang JS, Chung YH. A case of chylous ascites with chylothorax. J Korean Pediatr Soc 1984;27:174-7
  14. Kim KC, Cheong HI, Choi Y, Moon HR. A case of chylous ascites in an infant boy. J Korean Pediatr Soc 1980;23:63- 7
  15. Hong JH, Min BW, Lee GB, Mok YJ. Clinical analysis of chylous ascites after surgery for gastric cancer. J Korean Gastric Cancer Assoc 2002;2:20-5 https://doi.org/10.5230/jkgca.2002.2.1.20
  16. Unger SW, Chandler JG. Chylous ascites in infants and children. Surgery 1983;93:455-61
  17. Dillard RP, Stewart AG. Total parenteral nutrition in the management of traumatic chylous ascites in infancy. Clin Pediatr 1985;24:290-2 https://doi.org/10.1177/000992288502400513
  18. Andreou A, Papouli M, Papavasiliou V, Badouraki M. Postoperative chylous ascites in a neonate treated successfully with octreotide: bile sludge and cholestasis. Am J Perinatol 2005;22:401-4 https://doi.org/10.1055/s-2005-872588
  19. Bhatia C, Pratap U, Slavik Z. Octreotide therapy: a new horizon in treatment of iatrogenic chyloperitoneum. Arch Dis Child 2001;85:234-5 https://doi.org/10.1136/adc.85.3.234
  20. Edoute Y, Nagachandran P, Assalia A, Ben-Ami H. Transient chylous ascites following a distal splenorenal shunt. Hepatogastroenterology 2000;47:531-2
  21. Balsara KP, Dubash C. Chylous ascites following a Warren shunt. Indian J Gastroenterol 1987;6:243
  22. Freund H, Brewster D, Fischer JE. Total parenteral nutrition in post-Warren shunt chylous ascites. Arch Surg 1979;114:345
  23. Maywood BT, Goldstein L, Busuttil RW. Chylous ascites after a Warren shunt. Am J Surg 1978;135:700-2 https://doi.org/10.1016/0002-9610(78)90139-3
  24. Aalami OO, Allen DB, Organ CH Jr. Chylous ascites: a collective review. Surgery 2000;128:761-78 https://doi.org/10.1067/msy.2000.109502