Chyle leak post laparoscopic cholecystectomy: a case report, literature review and management options

Chyle leak after a laparoscopic cholecystectomy (LC) is very rarely reported. However, it is needs to be recognised promptly and managed as otherwise it can lead to further metabolic and infective complications. We present the case of a 48 years old man who was admitted with ultrasound proven acute calculous cholecystitis. His vital signs were within normal range but his murphy's sign was positive. His white cell count (WCC) and liver function tests were within normal limit. He underwent an uneventful standard LC with cholangiography during the same admission with no anomalous biliary or hepatic arterial anatomy noted during the procedure. Post operatively he was noted to have 125 mL of white fluid in his drain. The fluid triglyceride was 23.2 mmol/L cholesterol level was 2.8 mmol/L and drain/serum triglyceride of 15.5, hence confirming it to be chyle. He was clinically otherwise very well. He was managed conservatively as a low volume chyle leak with a fat free diet. The triglyceride content in the drain effluent decreased to 1.3mmol/L by day 6 and the fluid turned straw coloured in that interval. The drain was removed and the patient discharged home without any further issues. This is the 6 6 reported case of chyle leak after a LC for calculous disease in the English literature. The main 'take away' message is that although rare chyle leak should be considered even in uncomplicated LC. We include a review of previous cases, propose pathogenesis, diagnostic workup and a review of the options of management of this rare complication. We suggest a step-up approach to management of such leaks depending on severity.