Abstract

PERNALETE, Beatriz; RODRIGUEZ, Livia  and  LARA, Jacinto. Fístula quiloperitoneal en gestante a propósito de un caso. Gen [online]. 2010, vol.64, n.3, pp.206-207. ISSN 0016-3503.

The lymphatic system represents a vast network of capillaries and vessels distributed throughout the body, which converge at the thoracic cavity to a largest single structure, the thoracic duct, which drains its contents into the venous circulation to the left subclavian vein. Chylous fistula is defined as a loss of lymph from the lymphatic vessels, typically accumulated in the abdominal cavity and/or cage, occasionally manifested as an external fistula. (120) Conservative treatment of chylous fistula is recommended in most patients and shall be determined by high output fistulas causing early physiological changes, so treatment should be aggressive. Tumoral chylous fistulas are difficult to manage; treatment is more successful if these appear after trauma or surgery. To improve the effectiveness of conservative treatment, it has been suggested to associate the use of somatostatin or its analogs with the above mentioned measures. Surgical treatment is addressed when conservative therapy fails (40%). We present a case of a 39 years-old female, from the state of Nueva Esparta - Venezuela, with no known medical history, GESTA IV, III who underwent emergency cesarean section at 34 weeks due to fetus with polyhydramnios. When approaching the abdominal cavity they found a milky fluid of which they obtained 3000cc approx.; they took out the fetus which was in stable condition and examined the abdominal cavity without evidence of any pathology, whatsoever. She was discharged in stable condition, and comes back to consult at 7 days after due to increased abdominal volume. For this reason, she was referred to our center where several studies are made, such as laboratory studies which only reported anemia (Hb 10), tumor markers (alpha fetoprotein, Ca 19-9, CEA) negative, special tests to rule out clotting disorder were negative; negative immunological profile (ANCA, ANA, AMA, AML), CT Scan of the chest-abdomen and pelvis which concluded bilateral small pleural effusion and ascites. Normal Echo-Doppler of portal, suprahepatic and splenic veins, normal endoscopic studies, the cytochemical analysis of the fluid showed triglycerides in 652/dl, in view of these findings, the patient is again interrogated and reports that during pregnancy she fell down twice with consequence of trauma in the right costal region. Reviewing the literature, it was decided to ask for a lymphoscintigraphy, which concluded persistent hypercaptation, located in the epigastrium, with diffuse heterogeneous area that impresses subhepatic lymph extravasation probably related to peritoneal chylous fistula; with this result medical treatment based on octreotide, diuretic loops, parenteral nutrition with medium-chain triglycerides and absolute diet for 4 months was begun, with improvement of the condition. Currently, the patient is without ascites and asymptomatic; maintaining a low saturated fat diet.

Keywords : Chyloperitoneum.