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Lethal course of secondarily infected postoperative chylous ascites refractory to treatment

Ingmar Königsrainer, Corinna Wicke, Ibrahim Irkin, Kasimir Müller, Alfred Königsrainer

CaseRepClinPractRev 2006; 7:81-83

ID: 449533


Background: Postoperative chylous ascites is a rare complication of retroperitoneal and mediastinal surgery that represents a difficult management problem. We here present a case of a resected retroperitoneal recurrent liposarcoma with a consecutively infected retroperitoneal chylous fistula refractory to surgical and medical treatment.
Case Report: A 70-year-old male patient was operated because of retroperitoneal recurrence of a liposarcoma
diagnosed during a follow-up CT scan four years after en-bloc tumorectomy. He developed infected chylous ascites refractory to conservative treatment. Despite revision laparotomy four weeks later and intensive care treatment with broad spectrum antibiotic and
antimycotic therapy the fistula persisted in producing two to five liters a day. The patient died
two months after revision laparotomy.
Conclusions: Mindful of the possibility of secondary infection of ascites, especially when drainage is not complete, early reoperation and treatment with broad spectrum antibiotics should be discussed.

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