Báo cáo ca bệnh hiếm gặp áp dụng phẫu thuật nối ống ngực vào tĩnh mạch không dùng chỉ khâu điều trị tràn dịch dưỡng chấp ổ bụng do tắc ống ngực bẩm sinh

Abstract

Chylous ascites is an uncommon disorder resulting from lymphatic leakage or obstruction, leading to the accumulation of triglyceride-rich chyle within the peritoneal cavity. Congenital thoracic duct outflow obstruction represents an exceptionally rare etiology and is frequently associated with lymphedema and protein-losing enteropathy, culminating in persistent hypoalbuminemia. We describe a 20-month-old female presenting with chylous ascites, refractory hypoalbuminemia, recurrent infectious episodes, and severe protein–energy malnutrition. Magnetic resonance lymphangiography and conventional lymphangiography demonstrated a markedly dilated thoracic duct with complete occlusion at its termination into the right internal jugular–subclavian venous confluence. Comprehensive conservative management, including a chyle-restricted diet, intravenous octreotide infusion, and sirolimus therapy, failed to achieve clinical improvement. The patient subsequently underwent sutureless thoracic duct-to-vein anastomosis, which resulted in rapid resolution of ascites, progressive normalization of serum albumin levels, and no significant postoperative complication. This surgical approach appears to be a safe, feasible, and effective therapeutic option for cases refractory to optimal medical management.