Abstract | CASE: A 62-year-old man with cirrhosis, hepatitis C, and hepatocellular carcinoma, underwent a liver transplant. On day 11 after surgery, a chylous leak from a partial wound dehiscence was noted. The leak did not respond to 2 weeks of uninterrupted, fat-free clear liquid diet and 12-hour total parenteral nutrition at night. The same treatment was continued for another 6 weeks with fatty meal challenge every weekend, which he failed. He was then given a fat-free clear liquid diet, 24-hour total parenteral nutrition, and octreotide 100 μg subcutaneously every 8 hours for 14 days. A prompt response was noted. His recovery was excellent at the time of this writing (9 months' follow-up). DISCUSSION: CONCLUSIONS: If exploratory surgery is done for any other reason, it is best to identify a chylous leak and ligate it. Otherwise, we recommend octreotide combined with a fat-free, clear liquid diet, and supplementation with medium chain triglycerides and total parenteral nutrition from the outset.
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Authors | Amar Nath Mukerji, Esther Tseng, Andreas Karachristos, Manoj Maloo, Ashokkumar Jain |
Journal | Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation
(Exp Clin Transplant)
Vol. 11
Issue 4
Pg. 367-74
(Aug 2013)
ISSN: 2146-8427 [Electronic] Turkey |
PMID | 23688335
(Publication Type: Case Reports, Journal Article, Review)
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Chemical References |
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Topics |
- Carcinoma, Hepatocellular
(surgery, virology)
- Chylous Ascites
(diagnosis, etiology, therapy)
- Combined Modality Therapy
- Diet, Fat-Restricted
- Drainage
- Drug Administration Schedule
- Hepatitis C
(complications)
- Humans
- Liver Cirrhosis
(surgery, virology)
- Liver Neoplasms
(surgery, virology)
- Liver Transplantation
(adverse effects)
- Male
- Middle Aged
- Octreotide
(administration & dosage)
- Parenteral Nutrition, Total
- Reoperation
- Time Factors
- Treatment Outcome
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