Strangulated Intestinal Obstruction with Chylous Ascites—A Report of Two Cases

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 82; no. 11; pp. 1999 - 2005
• Main Authors: TANIMURA, Takuya, HASHIBA, Ryoya, KODA, Masaki, INAZU, Daiki, KATSURAGI, Kunihiro, KIYOTA, Satoshi
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2021
• Subjects: chylous ascites; strangulating intestinal obstruction
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.82.1999

Strangulated intestinal obstruction accompanied by chylous ascites is extremely rare. We report two cases of this rare clinical condition.Case 1 : A 98-year-old man with a history of surgery for rectal cancer and strangulated intestinal obstruction was transferred to our hospital as an emergency for evaluation of right-sided abdominal pain and vomiting. He underwent emergency laparotomy and was diagnosed with strangulated intestinal obstruction. We identified a band on the cranial umbilicus, and a segment of the small intestine measuring approximately 80 cm in length was strangulated. The lymph stands out as white vessels on the serous surface and mesentery of the strangulated intestinal tract, and we observed odorless, pinkish-white turbid ascites in the surrounding area.Case 2 : An 89-year-old man visited our hospital for evaluation of nausea and poor food intake over several days prior to presentation. He underwent emergency laparotomy and was diagnosed with strangulated intestinal obstruction. The entire small intestine on the anal aspect extending from the Treitz ligament was twisted counterclockwise by about 360° and was strangulated. The mesentery appeared partly white in color with prominent lymphatic vessels, and we observed a large amount of odorless, yellowish-white turbid ascites. The affected intestinal segments did not appear necrotic in both patients ; therefore, the operation was completed without intestinal resection, and both patients showed an uneventful postoperative course.