RAPID RESOLUTION OF CHYLOUS ASCITES AFTER LIVER-TRANSPLANTATION USINGSOMATOSTATIN ANALOG AND TOTAL PARENTERAL-NUTRITION

Chylous ascites is the accumulation of chylomicron-rich lymphatic flui d within the peritoneal cavity. It is a rare complication of retroperi toneal surgery, and may occur spontaneously in 0.5% of patients with c irrhosis. Its management is controversial, and despite a variety of tr eatment options with limited efficacy, the course is usually indolent. In this article, we report a case of rapid resolution of chylous asci tes after liver transplantation following 10 days of treatment using s omatostatin analog (Octreotide, 100 mu g s,c. t.i.d.) and total parent eral nutrition (TPN). A 55-year-old man underwent liver transplantatio n for hepatitis C cirrhosis, and developed an infected chylous fistula on the 10th day, Treatment by fasting, TPN, and somatostatin analog r esulted in a rapid falloff in fistula output, with complete resolution of ascites within 2 days. This is the first report, to our knowledge, of somatostatin analog and TPN used in combination for rapid and succ essful closure of a chylous fistula.