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• W2728326830 abstract "A 32-year-old man presented with severe abdominal pain and ascites. His medical history included diagnosis of Sandifer syndrome, scoliosis requiring 3 spinal surgeries, microgastria, and hiatal hernia repair, and most recently, laparoscopic cholecystectomy (7 weeks prior). Postprocedural abdominal pain led to a computed tomography (CT) 3 scan which confirmed ascites. The possibility of a postcholecystectomy common bile duct leak prompted an endoscopic retrograde cholangiopancreatography (ERCP) with stent placement. Unfortunately, this did not prevent peritoneal fluid from reaccumulating and the patient was transferred to our institution for further evaluation and management. The patient was afebrile and vital signs were normal. The abdominal examination revealed mild diffuse nonspecific tenderness. CT scan of abdomen was performed revealing increased peritoneal fluid. The radiologist noted that the findings were likely iatrogenic and could represent a bile, lymph, or pancreatic leak. CT guided paracentesis aspirated 280 mL of fluid accumulated near the right hepatic lobe and paracolic gutter. Aspirate was described as watery opaque and white with a pink tinge. Results of body fluid laboratory analyses are described in Table 1.View this table:Table 1. Body fluid testing laboratory results.Fluid accumulation after abdominal surgery could be the result of several etiologies. Definitive identification of the fluid source is critical to guide medical treatment. In this case, the increased amylase concentration in the fluid suggested pancreatic origin (1, 2). However, the aspiration of milky turbid fluid following paracentesis that contains a high concentration of triglycerides, as measured by a nonglycerol blanked assay, may lead the physician to include chylous ascites in the differential diagnoses. Chylous effusions are characterized by the presence of chyle in fluid accumulations in the pleural or peritoneal space following lymphatic obstruction or disruption (3). Chyle is composed of lymph and lipids suspended in chylomicrons, which are the largest lipid-carrying lipoprotein particles that carry mainly …" @default.
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• W2728326830 date "2017-07-01" @default.
• W2728326830 modified "2023-09-22" @default.
• W2728326830 title "A Man with Recurrent Ascites after Laparoscopic Cholecystectomy" @default.
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• W2728326830 doi "https://doi.org/10.1373/clinchem.2016.263756" @default.
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