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Chylous ascites following retroperitoneal lymphadenectomy for testes cancer

Nature Clinical Practice Urology volume 3, pages 226–232 (2006)Cite this article

Abstract

Background A 31-year-old man underwent a radical orchiectomy for a stage I mixed germ-cell tumor with angiolymphatic invasion. A subsequent laparoscopic retroperitoneal lymphadenectomy was complicated by a laceration to the aorta at the ostia of the more inferior of two right renal arteries. This was repaired following conversion to an open laparotomy. The patient presented 14 days later with genital swelling and increasing abdominal girth.

Investigations Physical examination, abdominal and pelvic CT, laboratory albumin testing, lymphoscintogram and lymphangiogram.

Diagnosis Chylous ascites with tracking of lymphatic fluid into the left groin through a defect in the internal inguinal ring.

Management Conservative management with salt restriction, a medium-chain fatty-acid diet and diuretics; exploratory laparoscopy, during which a small left inguinal hernia was repaired and chylous fluid was drained. Following further leakage, the patient was placed on total parenteral nutrition, followed by image-guided sclerotherapy with doxycycline.

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Figure 1: Representative CT images.
Figure 2: Drainage of chylous fluid during diagnostic laparoscopy.
Figure 3: Laparoscopic view of the defect in the left internal inguinal ring.
Figure 4: Lymphoscintographic images confirming ongoing lymphatic leak.
Figure 5: Right pedal lymphangiogram with fluoroscopically guided sclerotherapy.
Figure 6: Algorithm for the management of chylous ascites following retroperitoneal urologic surgery.

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Authors and Affiliations

  1. Associate Professor of Urology and a Director of the Division of Endourology and Minimally-Invasive Surgery in the Scott Department of Urology at Baylor College of Medicine, Houston, TX

    Richard E Link, Nivee Amin & Louis R Kavoussi

  2. Johns Hopkins University, School of Medicine, Baltimore, MD

    Richard E Link, Nivee Amin & Louis R Kavoussi

  3. Chairman of Urology for the North Shore–Long Island Jewish Health System, Manhasset, NY

    Richard E Link, Nivee Amin & Louis R Kavoussi

  4. Professor of Urology at New York University School of Medicine, New York, NY, USA

    Richard E Link, Nivee Amin & Louis R Kavoussi

Authors
  1. Nivee Amin
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  2. Louis R Kavoussi
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Correspondence to Richard E Link.

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The authors declare no competing financial interests.

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Link, R., Amin, N. & Kavoussi, L. Chylous ascites following retroperitoneal lymphadenectomy for testes cancer. Nat Rev Urol 3, 226–232 (2006). https://doi.org/10.1038/ncpuro0457

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  • DOI: https://doi.org/10.1038/ncpuro0457

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