Experimental Ascites: VII. The Effects of External Drainage of the Thoracic Duct on Ascites and Hepatic Hemodynamics

SINCE THE observations of Starling in 1894,¹ a number of studies have demonstrated a marked increase in the flow of lymph in the hepatic hilar lymphatics and thoracic duct in association with experimental ascites,^2-5 hepatic venous outflow obstruction,^6-8 and experimental cirrhosis.^9-11 A similar increase in lymph flow in the thoracic duct has been observed recently in humans with cirrhosis,^12-14 or congestive heart failure¹⁵; and the marked enlargement of the lymphatics in the hilum of the cirrhotic liver, so familiar to surgeons who have performed operations for portal hypertension, has been documented by a careful histopathologic study.¹⁶ Although the cause of the augmented production of hepatic lymph is not certain, the bulk of evidence indicates that it is in large part a mechanical phenomenon resulting from obstruction to the outflow of blood from the liver sinusoid and the consequent spill-over of the plasma portion