Chylous ascites after laparoscopic anterior resection of the rectum

Chylous ascites is a pathologic accumulation of chyle in the peritoneal cavity as a consequence of intra-abdominal chylous leakage.1 It may represent an infrequent postoperative complication that is usually due to unrecognized surgical discontinuity of intestinal and/or retroperitoneal lymphatics.1 It can also be caused by extensive occlusion of retroperitoneal lymphatics by malignancies, radiation, or tuberculosis.2 In the latter cases, the prognosis is unfavorable, with a mortality rate of 40% to 70% as the result of severe malabsorption.3 As far as we know, only 2 cases of chylous ascites after anterior resection of the rectum have been reported previously,3 and 4 but only in the case reported by Giovannini and coworkers4 does ascites appear to be a direct complication of surgery, whereas in the other one it was due to a neoplastic nodal recurrence 2 years after the operation. The purpose of the present article is to report 3 cases of chylous ascites as direct consequences of laparoscopic anterior resection of the rectum in order to focus on the hypothetic pathogenetic mechanisms and treatment of this uncommon but potentially dangerous complication.