Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Treatment of Refractory Chylous Ascites with an Innovative Peritoneovenous Shunt: Temporary Usage of a Continuous Renal Replacement System: A Case Report

  • Park, Jiyoun (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jae Jun (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jung Hee (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Shim, Young Mog (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2021.08.09
  • Accepted : 2021.10.08
  • Published : 2022.02.05
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Abstract

Esophagectomy and esophageal reconstruction are commonly chosen as surgical options for esophageal cancer. However, prolonged untreated chyle leakage is associated with a poor prognosis. We report the case of a patient with refractory chylous ascites. To limit the ongoing fluid loss, we utilized the chylous ascites as an additional fluid source in a renal replacement therapy system. A continuous renal replacement therapy (CRRT) drainage system was modified to drain both the chylous ascites and venous blood. The ascites drainage rate was determined empirically and regulated by a dial-flow extension set. The CRRT mode was set to continuous venovenous hemodiafiltration and maintained for 7 days. After the patient was weaned from CRRT, ascites did not reaccumulate, and the patient's general condition improved dramatically. No infections related to the system occurred. This procedure temporarily alleviates symptoms and provides more time for alternative treatment strategies.

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References

  1. Lagarde SM, Omloo JM, de Jong K, Busch OR, Obertop H, van Lanschot JJ. Incidence and management of chyle leakage after esophagectomy. Ann Thorac Surg 2005;80:449-54. https://doi.org/10.1016/j.athoracsur.2005.02.076
  2. Weijs TJ, Ruurda JP, Broekhuizen ME, Bracco Gartner TC, van Hillegersberg R. Outcome of a step-up treatment strategy for chyle leakage after esophagectomy. Ann Thorac Surg 2017;104:477-84. https://doi.org/10.1016/j.athoracsur.2017.01.117
  3. Yang YH, Park SY, Kim DJ. Chyle leakage after esophageal cancer surgery. Korean J Thorac Cardiovasc Surg 2020;53:191-9. https://doi.org/10.5090/kjtcs.2020.53.4.191
  4. Yarmohammadi H, Brody LA, Erinjeri JP, et al. Therapeutic application of percutaneous peritoneovenous (Denver) shunt in treating chylous ascites in cancer patients. J Vasc Interv Radiol 2016;27:665-73. https://doi.org/10.1016/j.jvir.2015.12.014
  5. Onichimowski D, Goraj R, Jalali R, Grabala J, Mayzner-Zawadzka E, Czuczwar M. Practical issues of nutrition during continuous renal replacement therapy. Anaesthesiol Intensive Ther 2017;49:309-16.
  6. Honore PM, De Waele E, Jacobs R, et al. Nutritional and metabolic alterations during continuous renal replacement therapy. Blood Purif 2013;35:279-84. https://doi.org/10.1159/000350610
  7. VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 2008;359:7-20. https://doi.org/10.1056/NEJMoa0802639
  8. RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med 2009;361:1627-38. https://doi.org/10.1056/NEJMoa0902413
  9. Huang Y, Gloviczki P, Duncan AA, et al. Management of refractory chylous ascites with peritoneovenous shunts. J Vasc Surg Venous Lymphat Disord 2017;5:538-46. https://doi.org/10.1016/j.jvsv.2017.03.011