38 year old male patient admitted to the Nutrition Unit due to chylous ascites.
He had a history of smoking and repeated nephritic colic.
8 months prior to our consultation, he was diagnosed with left testicular seminoma with retroperitoneal lymph nodes (stage II C).
Surgery was performed by left radical orchiectomy.
The patient was treated with chemotherapy with the BEP protocol (3 cycles of Bleomycin-Episplatinum-Etoposide, and a fourth cycle of Cisplatin-E, later on).
After chemotherapy there was a significant decrease in the size of the adenopathic mass (4.2 x 3 cm in its maximum diameter versus 11 x 6 cm initial), but in view of the persistence of the adenopathies it was decided to perform retroperitoneal lymphadenectomy.
The procedure was uneventful in the immediate postoperative period, but three weeks after surgery the patient consulted for pain and abdominal discomfort.
Physical examination revealed a distended, hard, diffusely painful abdomen with signs of ascites.
Abdominal ultrasound showed significant ascites.
Abdominal computed tomography detected postsurgical changes of retroperitoneal lymphadenectomy and significant amount of free intra-abdominal fluid.
Defecation paracentesis was performed with extraction of 8,000 cc of ascitic fluid appearance resected triglycerides.The analysis of this fluid showed: leukocytes 508/mm3, Polymorphonuclear 14%, Mononuclear 86%,
Three paracentesis were performed on an extra weekly basis 3, evacuation 7, and 4 successive evacuations.
At the Nutrition Clinic, the patient reported moderate asthenia with a feeling of early post-pandrial plenity.
Physical examination revealed weight 66 kg, height 177 cm, ideal weight 79.2 kg, BMI 21.06, tricipital fold 12 mm (91.8% p50), normal abdominal circumference and pleural effusion 115 bpm (89% p50).
Serum levels showed: glucose 92 mg/dl (60-100), creatinine 1.2 mg/dl (0.8-1.3), 7.9 mg/dl positive serum creatinine (3.5-7.2), serum creatinine 1.280 mg/dl (0.8-1.30) normal serum ferritin (37 mg/dl), serum creatinine 150 mg / dl (3.5), serum creatinine + platelet count (3.5), serum creatinine + 32
The patient was diagnosed with mild protein-calorie malnutrition in the context of chylous ascites secondary to retroperitoneal lymphadenectomy.
A hyperproteic diet was initiated with restriction of one specific fat supplement in 5-6 daily intakes along with MCT 20 ml daily, zinc sulfate 1 tablet daily, a multivitamin complex and 100 grams daily of MCT.
This supplement provides 424 kcal and 11.4 grams of protein per 100 grams.
With this therapeutic approach, the patient only required an evacuating paracentesis and 3 months later presented the following anthropometric data: weight 70.1 kg, triceps skinfold 13 mm of the arm 23 cm previously altered (93% p 50), muscle circumference
