Transjugular Intrahepatic Portosystemic Shunt Is a New Standard for Treatment of Chylus Ascites Associated With Liver Cirrhosis

The article describes a clinical case of treatment of refractory chylous ascites using TIPS in a patient with cirrhosis of the liver who underwent 2 operations disconnecting the portacaval system: ligation of the varicose veins and the Patziora operation (division of the portal and azygos veins). As a result of the treatment, the patient was discharged from the hospital in satisfactory condition; during a further 7 months of outpatient observation, there were no relapses of chylous ascites or other signs of free fluid accumulation in the abdominal cavity. The proposed treatment method is particularly important because chylous ascites is a rare complication of liver cirrhosis, with a mortality rate of 40–70%. The question of the optimal treatment tactic remains relevant. The general initial approach to treatment is the administration of diuretics and correction of the patient's diet: reducing salt and fat intake; if ineffective, laparocentesis is used. Since CA's aetiopathogenesis is based on portal hypertension syndrome, the operations of choice have become various options for porto-caval shunting or uncoupling operations for decompensation of portal hypertension, such as the Patziora operation. Still, the safest and most reliable approach is transjugular intrahepatic portosystemic shunting.