Chyloperitoneum after blunt abdominal injury

The objective of this study was to evaluate incidence of chylous injury in blunt trauma using a retrospective chart review. We present two patients who sustained chyle duct injury after blunt trauma. The first patient is a pedestrian struck by car. Abdominal CT scan revealed duodenal thickening and...

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Bibliographic Details
Published in:The American surgeon 2007-08, Vol.73 (8), p.811-813
Main Authors: HAAN, James M, MONTGOMERY, Stephanie, NOVOSEL, Timothy J, STEIN, Deborah M, SCALEA, Thomas M
Format: Article
Language:English
Subjects:
Abdominal Injuries - complications
Abdominal Injuries - diagnosis
Accidents, Traffic
Adult
Anastomosis, Surgical
Back surgery
Biological and medical sciences
Chylous Ascites - diagnosis
Chylous Ascites - etiology
Chylous Ascites - therapy
Colectomy - methods
Enteral Nutrition - methods
Follow-Up Studies
General aspects
Humans
Injuries
Male
Medical sciences
Multiple Trauma
Parenteral nutrition
Patients
Tomography, X-Ray Computed
Trauma Severity Indices
Wounds, Penetrating - complications
Wounds, Penetrating - diagnosis
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Summary:The objective of this study was to evaluate incidence of chylous injury in blunt trauma using a retrospective chart review. We present two patients who sustained chyle duct injury after blunt trauma. The first patient is a pedestrian struck by car. Abdominal CT scan revealed duodenal thickening and a moderate amount of paraduodenal fluid, which prompted surgical exploration. At laparotomy, the patient was found to have a disruption of his lymphatics at the level of the inferior vena cava (IVC) without duodenal injury treated with hemoclips, fibrin sealant and elemental gastrojejunal feeds. The second patient was involved in a high speed motor vehicle collision (MVC) resulting in transection of the mesentery of the transverse colon. Disrupted lacteals were treated intra-operatively with hemoclips and fibrin sealant decreasing the lymph leak. In both cases, the leak completely resolved with use of tube feedings with medium chain triglycerides. On literature review, six prior patients with spontaneous chylous retroperitoneum were described undergoing similar operative management. Chylous leakage due to blunt trauma is a rare finding. Mechanism of injury includes hyperextension or flexion resulting in stretching and shearing of the tethered lymphatics. Open ligation or clipping of the injured ducts seems effective. Tube feeds with medium chain triglycerides may enhance efficacy of operative treatment.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313480707300816