Endoscopic drainage of an intra-abdominal chylous collection

Introduction

Chylous leak is an increasingly recognised complication following pancreatic surgery. It results from the disruption of the lymphatic system and may lead to persistent chylous ascites or collection. Ongoing chyle loss is associated with significant morbidity including malnutrition, dehydration, electrolyte disturbance, hypoalbuminaemia, immunosuppression and impaired wound healing. Clinicians managing patients in the perioperative setting should remain vigilant for the development of chylous leak, particularly following high-risk surgery. While most cases respond to conservative management with dietary modification and use of somatostatin analogues, refractory cases remain challenging and may require technically demanding or morbid interventions. We report a novel minimally invasive approach using endoscopic ultrasound-guided cyst gastrostomy for a post-operative chylous collection.