Departmental Bulletin Paper A case report validating the usefulness of cell-free and concentrated ascites reinfusion therapy for the treatment of exacerbation of chronic renal failure caused by lymphorrhea after surgery for bile duct cancer

Uramatsu, Tadashi  ,  Obata, Yoko  ,  Kamijo, Masafumi  ,  Muta, Kumiko  ,  Kitamura, Mineaki  ,  Kawasaki, Satoko  ,  Hirose, Misaki  ,  Nishikido, Masaharu  ,  Mukae, Hiroshi  ,  Nishino, Tomoya

61 ( 1 )  , pp.17 - 21 , 2017-01 , Nagasaki University School of Medicine
This is a case study on a 72-year-old man receiving continuous outpatient treatment since 2008 after a diagnosis of chronic renal failure due to diabetic nephropathy. In August 2010, he underwent pylorus-preserving pancreaticoduodenectomy for a middle bile duct carcinoma. He was transferred to our department at 39 days after surgery because of exacerbation of renal function, as well as prolonged ascites and anorexia after the surgery. The tests for malignant tumor, bacterial infection, tuberculosis, and ascitic fluid due to cirrhosis, done after his transfer, all showed negative results. Postoperative lymphorrhea was diagnosed on the basis of his clinical course and the feature of the ascites being similar to serum. Because the exacerbation of renal function was thought to be caused by a reduction of renal blood flow due to lymphorrhea, cell-free and concentrated ascites reinfusion therapy (CART) was performed for a total of two times. Consequently, the patient showed an increase in urine volume and improvement of renal function: creatinine was decreased to 1.99 mg/dL from 3.86 mg/dL. His course of ascites was observed conservatively with CART treatment, and the ascites gradually decreased and disappeared. We report a case that validates the usefulness of CART for treating exacerbation of chronic renal failure caused by lymphorrhea after surgery.

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