J Chest Surg.  2022 Feb;55(1):81-84. 10.5090/jcs.21.090.

Treatment of Refractory Chylous Ascites with an Innovative Peritoneovenous Shunt: Temporary Usage of a Continuous Renal Replacement System: A Case Report

• Park J
• Lee JJ
• Lee JH
• Shim YM

• KMID: 2525276
• DOI: http://doi.org/10.5090/jcs.21.090

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.

Keyword

Chylous ascites; Chylothorax; Peritoneovenous shunt; Esophageal neoplasms; Continuous hemodiafiltration shunt; Case report