Kuboki et al evaluated patients for chylous ascites following hepatopancreatobiliary surgery. The authors are from Chiba University in Japan.
Criteria for chylous ascites:
(1) milky fluid
(2) >= 100 mL per day
(3) fluid triglyceride concentration >= 110 mg/dL (>= 1.2 mmol/L)
(4) normal fluid amylase concentration
Hepatopancreatobiliary surgical procedures which are more likely to be associated with chylous ascites:
(1) liver transplant recipient
(2) pancreatic resection
Risk factors for chylous ascies after pancreatic resection:
(1) retroperitoneal tumor invasion
(2) manipulation of the para-aortic area
(3) early enteral feeding after the operation
Management:
(1) Patients with chylous ascites were treated with octreotide therapy and TPN.
(2) Patients who were improving were placed on a diet with low fat or medium chain triglycerides.
(3) When chylous ascites has resolved (volume < 100 mL per day, fluid triglyceride concentration < 110 mg/dL) then drains were removed and the patient was placed on a normal diet.
