A Novel Approach to Recalcitrant Postoperative Chylous Ascites in Liver Re-Transplantation: A Case Report

Abstract

Introduction:

Chylous ascites (CA) is characterized by accumulation of chyle in the peritoneal. In this report we have discussed our experience with a special home-made platelet-rich plasma (PRP)-fibrin glue (FG) as a last resort for treatment of a challenging case of post-operative CA.

Case Presentation:

A 25 years old, ill woman was admitted with severe ascites and hepatic encephalopathy in our center. She was a known case of autoimmune hepatitis and cirrhosis who had undergone liver transplantation 5 years ago and unfortunately developed chronic rejection. During the surgery we noticed an old organized thrombosis in the portal vein and used an iliac vein graft to bypass the superior mesenteric vein. After surgery chylous ascites was developed. Having no other choice, based on our experience with PRP-FG in similar situations we decided to use this method as a last resort to treat post-operative chylous ascites.

A special home-made PRP-FG was prepared for the patient and 90 mL of that, was injected to abdominal cavity via the drainage tube followed by a 25 mL of isotonic saline solution to prevent clot formation in the tube.

Few days after treatment, chylous secretion was decreased and then completely ceased. Finally, she was discharged in good health and advised to return to the clinic for follow up.

Conclusion:

It can be concluded that when conservative management did not work for treatment of postoperative chylous ascites in intractable cases, PRP-FG can be considered a last resort for treatment.