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Therapeutic Intranodal Lymphangiography for Refractory Chylous Ascites Complicating Acute Necrotic Pancreatitis

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Thomas Jardinet1, Len Verbeke2, Lawrence Bonne1, Geert Maleux1

1) Department of Radiology, University Hospitals Leuven, Leuven
2) Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven Belgium

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.272.the

ABSTRACT
Chylous ascites is a rare complication of acute pancreatitis. However, the incidence of intraperitoneal chyle leakage related to severe pancreatitis may be much higher. This is probably the result of direct damage to the cisterna chyli or its tributaries by pancreatic enzymes. In this case, conservative treatment failed to resolve the chyle leak. For the first time, to our knowledge, ultrasound guided therapeutic intranodal lymphangiography was shown to be a successful, minimally invasive treatment option in chylous ascites complicating acute necrotic pancreatitis.
Key words: chylous ascites – pancreatitis – lymphangiography.
Abbreviations LCT: long chain triglycerides; MCT: medium chain triglycerides; TPN: total parenteral nutrition; WON: walled-off necrosis.