Laparoscopic management of the congenital chylous ascites in a newborn: Case report

被引:0
|
作者
Zahradnikova, Petra [1 ,3 ,4 ]
Pechanova, Rebeka [1 ]
Fedorova, Lenka [1 ]
Jager, Rene [1 ]
Nedomova, Barbora [2 ]
Babala, Jozef [1 ]
机构
[1] Comenius Univ, Natl Inst Childrens Dis Bratislava, Fac Med, Dept Paediat Surg, Bratislava, Slovakia
[2] Comenius Univ, Natl Inst Childrens Dis Bratislava, Fac Med, Dept Paediat Anaesthesiol & Intens Med, Bratislava, Slovakia
[3] Comenius Univ, Fac Med, Dept Pediat Surg, Bratislava, Slovakia
[4] Natl Inst Childrens Dis, Bratislava, Slovakia
关键词
Chylous ascites; congenital ascites; fibrin glue; laparoscopy in newborn; newborn surgery;
D O I
10.4103/jmas.jmas_304_22
中图分类号
R61 [外科手术学];
学科分类号
摘要
Congenital chylous ascites (CCA) is a rare condition seen in the neonatal period. The pathogenesis is primarily related to congenital intestinal lymphangiectasis. Conservative treatment of chylous ascites involves paracentesis, total parenteral nutrition (TPN), medium-chain triglyceride (MCT)-based milk formula, use of somatostatin analogue and octreotide. Surgical treatment is considered when conservative treatment fails. We describe a laparoscopic treatment of CCA using the fibrin glue technique. A male infant, in whom foetal ascites was detected at 19 weeks of gestation, was born by caesarean section at 35 weeks of gestation weighing 3760 g. There was evidence of hydrops in the foetal scan. A diagnosis of chylous ascites was made by abdominal paracentesis. A magnetic resonance scan was suggestive of gross ascites, and no lymphatic malformation was identified. TPN and octreotide infusion was started and continued for 4 weeks, but the ascites persisted. The failure of conservative treatment led us to perform laparoscopic exploration. Intraoperatively, chylous ascites and multiple prominent lymphatic vessels around the root of the mesentery were noted. The fibrin glue was applied over the leaking mesenteric lymphatic vessels in the duodenopancreatic region. Oral feeding was started from post-operative day 7. After 2 weeks of the MCT formula, ascites progressed. Thus, laparoscopic exploration was necessary. We introduced an endoscopic applicator for fibrin glue and applied it into the place of leakage. The patient was doing well with no appearance of ascites reaccumulating and was discharged on the 45th post-operative day. Follow-up ultrasonography (1st, 3rd and 9th months after discharge) showed a small amount of ascitic fluid but with no clinical significance. Laparoscopic localisation and ligation of leakage sites could be difficult, especially in newborns and young infants due to the small size of lymphatic vessels. The use of fibrin glue to seal the lymphatic vessels is quite promising.
引用
收藏
页码:548 / 551
页数:4
相关论文
共 50 条
  • [1] Coexistence of Congenital Chylous Ascites and Congenital Hypothyroidism: Case Report
    Altunhan, Huseyin
    Annagur, Ali
    Ertugrul, Sabahattin
    Yuksekkaya, Hasan Ali
    Ors, Rahmi
    TURKIYE KLINIKLERI TIP BILIMLERI DERGISI, 2012, 32 (05): : 1486 - 1489
  • [2] Chylous ascites after laparoscopic donor nephrectomy: Case report
    Bhandari, Gaurav
    Tiwari, Vaibhav
    Gupta, Anurag
    Bhargava, Vinant
    Malik, Manish
    Gupta, Ashwani
    Bhalla, Anil Kumar
    Rana, D. S.
    INDIAN JOURNAL OF NEPHROLOGY, 2021, 31 (05) : 482 - 484
  • [3] Chylous Ascites Following Laparoscopic Donor Nephrectomy: A Case Report
    Buksh, Omar
    Almalki, Abdullah M.
    Jar, Anfal
    Alzahrani, Hani
    Bitar, Hussam
    Al-Akraa, Mahmoud
    CUREUS JOURNAL OF MEDICAL SCIENCE, 2023, 15 (05)
  • [4] Surgical management of congenital chylous ascites
    Albaghdady, Ayman
    El-Asmar, Khaled M.
    Moussa, Mohamed
    Abdelhay, Sameh
    ANNALS OF PEDIATRIC SURGERY, 2018, 14 (02): : 56 - 59
  • [5] Laparoscopic management of refractory chylous ascites using fluorescence navigation with indocyanine green: A case report
    Shimajiri, Hiroto
    Egi, Hiroyuki
    Yamamoto, Masateru
    Kochi, Masatoshi
    Mukai, Shoichiro
    Ohdan, Hideki
    INTERNATIONAL JOURNAL OF SURGERY CASE REPORTS, 2018, 49 : 149 - 152
  • [6] Chylous ascites following laparoscopic living donor nephrectomy Case report
    Gagliano, Massimiliano
    Veroux, Pierfrancesco
    Corona, Daniela
    Cannizzaro, Matteo Angelo
    Giuffrida, Giuseppe
    Giaquinta, Alessia
    Veroux, Massimiliano
    ANNALI ITALIANI DI CHIRURGIA, 2011, 82 (06) : 499 - 503
  • [7] A female infant with phacomatosis pigmentovascularis and congenital chylous ascites A case report
    Xu, Shuai
    Zhang, Qinming
    Liu, Tingting
    Zhang, Ye
    Sun, Ning
    MEDICINE, 2018, 97 (34)
  • [8] Diagnosis and management of congenital neonatal chylous ascites
    Mouravas, V
    Dede, O.
    Hatziioannidis, H.
    Spyridakis, I
    Filippopoulos, A.
    HIPPOKRATIA, 2012, 16 (02) : 175 - 180
  • [9] Management of chylous ascites and chylothorax. Report of one case
    Jofre, Paulina
    Grassi, Bruno
    Benitez, Carlos
    REVISTA MEDICA DE CHILE, 2020, 148 (08) : 1202 - 1206
  • [10] Management of chylous ascites after liver cirrhosis: A case report
    Chen, Zong-Qiang
    Zeng, Shu-Jun
    Xu, Chun
    WORLD JOURNAL OF HEPATOLOGY, 2025, 17 (01)