Diagnosis and management of primary chylous ascites

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Diagnosis and management of primary chylous ascites Corradino Campisi, MD, Carlo Bellini, MD, PhD, Costantino Eretta, MD, Angelo Zilli, MD, Elisa da Rin, MD, Doris Davini, MD, Eugenio Bonioli, MD, Francesco Boccardo, MD, PhD Journal of Vascular Surgery Volume 43, Issue 6, Pages 1244-1248 (June 2006) DOI: 10.1016/j.jvs.2005.11.064 Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 1 Lymphoscintigraphy in a patient affected by chylous ascites and chylous edema of the genitalia. Time after injection is 20 minutes in both panels. A, Before microsurgery. Lymphatic back-flow towards the genitalia and lower limbs is evident. B, After microsurgical correction consisting of lymphatic venous anastomosis bilaterally at the groin, and ligation of incompetent lymph vessels at the iliac and lumbar-aortic area. The patency of microlymphatic venous anastomosis is demonstrated by an earlier liver trace uptake, as can be seen in Panel B (arrow), and by the disappearance of previously highlighted back-flow at the genitalia. Journal of Vascular Surgery 2006 43, 1244-1248DOI: (10.1016/j.jvs.2005.11.064) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 2 Lymphography in a patient affected by chylous ascites and chylous edema of the genitalia. Note the localized dysplasia of lymphatic and lymphonodal structures in the periaortic and iliac-inguinal regions. Journal of Vascular Surgery 2006 43, 1244-1248DOI: (10.1016/j.jvs.2005.11.064) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 3 Intraoperative picture shows dilated lymphatic collectors of the intestinal wall (vasa lactea). Journal of Vascular Surgery 2006 43, 1244-1248DOI: (10.1016/j.jvs.2005.11.064) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions