Successful management of refractory chylous ascites using a Denver shunt following conversion surgery for unresectable locally advanced pancreatic cancer.
Dongha Lee, Keiko Kamei, Masaya Nakano et al.
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Case in brief
A 55-year-old woman developed refractory chylous ascites six months after distal pancreatectomy with celiac axis and portal vein resection for locally advanced pancreatic cancer. Conservative treatment, lymphangiography, and repeated paracentesis were ineffective. After negative cytology, culture, and endotoxin tests, a Denver shunt was placed on postoperative day 425. Ascites resolved rapidly, with improvement in body weight and hypoalbuminemia; she was discharged without early major complications. The shunt was removed 29 months later because of internal jugular vein thrombosis, without subsequent ascites recurrence. At 60 months after curative resection, she remained alive without ascites or tumor recurrence.
What made this case unusual
The shunt was removed for internal jugular vein thrombosis, yet ascites did not recur thereafter.
Diagnostic / clinical pearl
In this case, refractory postoperative chylous ascites persisted despite conservative measures, lymphangiography, and repeated paracentesis; Denver shunt placement was followed by rapid resolution.
Why it matters
The report describes a possible salvage option for postoperative refractory chylous ascites when conservative approaches fail, while emphasizing careful patient selection because of potential complications.