Chyloperitoneum As a Complication of Laparoscopic Roux-En-Y Gastric Bypass (LRYGB): A Case Report and Review of the Literature

Cade C Cinnamond, DO, Zachary D Adams, MD, Michael Barker, MD. Naval Medical Center Portsmouth

Chyloperitoneum is an extremely rare complication of laparoscopic Roux-en-Y gastric bypass (LRYGB) with only one other case reported in the literature. By definition, chyloperitoneum is the presence of chyle in the peritoneal cavity described as a turbid, milky fluid with a triglyceride concentration over 200 mg/dL (1). We describe the second known case of chyloperitoneum as a complication of LRYGB in a 57 year old female who previously had an uncomplicated gastric bypass in 2008. In April 2010, the patient presented to clinic for follow-up with a complaint of chronic abdominal pain that had recently worsened. An abdominal CT scan at that time showed ascites and the presence of an internal hernia. Diagnostic laparoscopy revealed a large amount of chylous fluid and a herniation of the common channel through a mesenteric defect. The hernia was reduced, the defect was repaired, and her postoperative recovery was uneventful. Since discharge she has had resolution of her preoperative pain without recurrence of chylous ascites. Chyloperitoneum, although extremely uncommon, can be a cause of abdominal ascites in the post-operative LRYGB patient with an internal hernia.