Purpose: The purpose of this presentation is show a case of chylous ascites as a complication of pancreatoduodenectomy in a patient with pancreatic adenocarcinoma, successfully managed with two sessions of percutaneous transhepatic lymphatic embolization.
Material and Methods: This was a case report of a 70 years old man with chylous ascites after a Whipple procedure. The patient was treated with dietary measures and placement of an abdominal paracentesis catheter. Persistent high debit (2 liter/day) of chylous ascites and bad response to the therapy carried to develop of severe proteo-caloric malnutrition. Percutaneous transhepatic lymphatic embolization was performed in two sessions. Percutaneous transhepatic access was gained to right and left hepatic lympatics vessels with a Chiba 21G needle under ultrasound and fluoroscopic guidance. In the first procedure 0,1 mL histoacryl/lipiodol 1:5 was used and 0,1 mL 1:4 in the second session.
Results: After first session we obtained a decrease of the debit of chylous ascites from 2 liter/day to 0,5 liter/day. After second session we achieved complete improvement of symptoms, with 0 liter/day ascites debit.
Conclusions: Chylous ascites is a rare condition with serious nutritional and immunological consequiences. Percutaneous transhepatic lymphatic embolization was an effective therapy in this case of refractory chylous ascites.
