Nichole E. Zayan1, Timothy D. Wetzel1, Eleanor Fung1 and Boris Zevin1,2*
1Department of Surgery, Ohio State University, USA
2Department of Surgery, Queen’s University, Canada
Roux-en-Y gastric bypass (RYGB) is one of the most frequently preformed bariatric and metabolic procedures worldwide. It can present with both early and late complications. We report a case of chylous ascites due to internal hernia in a patient who underwent open RYGB surgery 13 years prior. The patient presented with acute on chronic left upper quadrant abdominal pain with radiation to the left flank. CT scan of the abdomen and pelvis with oral and IV contrast demonstrated mesenteric and small bowel edema with a twist in the mesentery and poor pacification of the distal portion of the superior mesenteric vein, consistent with an internal hernia. At diagnostic laparoscopy internal hernia was reduced, mesenteric defect was closed, and cream-colored peritoneal fluid with elevated triglycerides (771 mg/dL) was identified. A diagnosis of chylous ascites due to obstruction of lymphatic channels from an internal hernia post RYGB was made. Internal hernia is a known complication of RYGB, which can infrequently present as chylous ascites. Surgical reduction of internal hernia and closure of mesenteric defects results in resolution of chylous ascites.
Zayan NE, Wetzel TD, Fung E, Zevin B. Chylous Ascites in the Setting of Roux- En-Y Gastric Bypass: Case Report and Review of the Literature. Clin Surg. 2016; 1: 1161.