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March 1979

Total Parenteral Nutrition in Post-Warren Shunt Chylous Ascites

Arch Surg. 1979;114(3):345. doi:10.1001/archsurg.1979.01370270115026

Attention has been recently called to the serious complication of chylous ascites after a distal splenorenal shunt.1 It seems that most patients with nonresponsive ascites after a distal splenorenal shunt fall into the category of chylous ascites, the reason being a division of intestinal lymphatics that are the presumed vessels involved in the chylous leak resulting in chylous ascites.2 Medical therapy of this complication was spoken of as being futile, with patients doomed to intractable ascites for the most part and/or operative intervention of Leveene shunt. We wish to bring attention to the fact that conservative therapy using parenteral nutrition and the principles of bowel rest, with the provision of adequate nutrition together with diuresis, will sometimes result in the correction of this serious complication.

Report of a Case.—A 43-year-old man underwent distal splenorenal shunt for the third episode of variceal bleeding. Ascites was noted on the