Chylous ascites after laparoscopic hand-assisted donor nephrectomy: Is it specific for the left-side?
A 34-year-old woman was subjected to an HALDN of the left kidney. The dissection and sealing of all tissues around the kidney and the renal hilar vessels were performed with the Ethicon® Ultracision harmonic scalpel. There were no intraoperative complications. The postoperative course of the donor was uneventful; she was discharged after 5 days. After one week, she presented with complaints of abdominal bloating and constipation. Physical examination showed a distended abdomen. An ultrasound revealed a significant amount of free fluid. Ultrasound-guided paracentesis aspirated a significant amount of creamy pink fluid. Laboratory tests of the fluid showed a creatinine of 69 μmol/l (the unit μmol/l is correct), triglyceride of 45.85 mmol/l, and 4.0 × 109 leucocytes and it was considered as chyle. A paracentesis drain was left in the abdomen. A total of 4.5 l chyle was aspirated by paracentesis. Patient was treated with octreotide three times, 0.1 mg a day subcutaneously, and was placed on medium-chain triglycerides (MCT) diet. The symptoms improved quickly and the drain was removed after 2 days. After 6 days, patient was discharged and maintained on an MCT diet for 6 weeks. There was no reoccurrence of the ascites. A repeated ultrasound showed absence of abdominal free fluid.