A47-31 Concurrent Chylothorax and Chylous Ascites. A Rare Complication Following Nephrectomy

Abstract Introduction Chylous ascites and chylothorax are rare conditions that involve the accumulation of lymphatic fluid in the peritoneal cavity and pleural space, respectively. These may result from thoracic surgery, trauma, tuberculosis, and non-Hodgkin lymphoma. 1-3 The simultaneous occurrence of both chylothorax and chylous ascites is exceptionally rare. We present a case of concurrent chylothorax and chylous ascites following a nephrectomy, marking the first documented instance of this dual complication post-surgery. Case A 65-year-old male with a history of left renal cell carcinoma presented three months post-nephrectomy with progressive shortness of breath over three weeks. This respiratory difficulty was accompanied by an increase in abdominal distension during the same timeframe. A CT scan of the chest identified a large right pleural effusion with ascites. Thoracentesis was performed, yielding 1100 mL of milky, chylous effusion. A paracentesis showed similar results. Bacterial and fungal cultures, acid-fast bacillus smear, and cytology, were negative. Notably, the patient did not have any recent travel history or identified risk factors for tuberculosis. A chest tube and an abdominal drain were placed and he was started on somatostatin and total parenteral nutrition (TPN). Discussion Chylous ascites and chylothorax are exceedingly rare conditions, with chylous ascites occurring in only about 0. 013% of cases following a nephrectomy. 4, 5 Chylothorax, on the other hand, has a reported incidence of 0. 85% to 6. 6%, often due to laceration of the thoracic duct in trauma cases. 2 There are only a few documented cases of simultaneous chylothorax and chylous ascites, including instances in patients with tuberculosis as reported by Gada et al. , in chemotherapy for non-small cell lung cancer by Arai et al. , in prostate cancer as noted by Shimizu, and in hepatic cirrhosis as described by Ibuki et al. ⁶-9 Our report is the first to document simultaneous chylothorax and chylous ascites following a nephrectomy. In our patient’s case, a suspected blockage of lymphatic channels after nephrectomy led to chylous ascites, which then migrated through the diaphragm, causing chylothorax. Despite thorough investigations, no other causes for the chylous ascites were found. Management involved conservative strategies, mainly nutritional diversion with TPN and somatostatin, which significantly reduced the chylous output. We suspect that the nephrectomy inadvertently damaged the para-aortic lymphatic vessels, resulting in the chylous leak. This case is notable not only for the simultaneous occurrence of chylous ascites and chylothorax but also for its unusual timing; chylous leaks typically occur within 2-3 weeks post-nephrectomy, unlike the three-month delay seen here. This abstract is funded by: Self