Title: Chylothorax with chylous ascites, successfully controlled by pleuro-peritoneal and peritoneo-venous shunts
Abstract: A 29-year-old male patient was referred to our hospital because of bilateral chylothorax. He was first treated with bilateral closed pleural drainage and intravenous hyperalimentation. He lost 2000-2500 cc of chyle every day. One month later, when the right pleural effusion had decreased in volume, a left pleuroperitoneal shunt was placed, which controlled the effusion on the left thereafter. As serous effusion accumulated in the right pleural space again, transthoracic supradiaphragmatic thoracic duct ligation was performed, but the chylous leak continued undiminished. Two months later, the right pleural effusion decreased spontaneously, and ascites appeared. A peritoneo-venous shunt was interposed to control the ascites without loss of fluid. It was appropriate to use a double-valved shunt tube to prevent occlusion. Chyle was returned to the vein, and the normal physiological route was restored. His nutritional state returned to normal. He was discharged on a low fat diet and is doing well.