Abstract
423
Objectives: Intestinal Lymphangiectasia causes protein losing enteropathy due to elevated of the intestinal pressure and obstruction of lymphatic drainage, which leads to hypoalbuminemia. Thoracic duct decompression operation is known to be able to promote lymphatic drainage, reduce intestinal pressure and thus improve the symptoms of protein losing enteropathy in some patients suffering intestinal lymphagiectasia. The purpose of this investigation is to determine whether the result of lymphoscintigraphy can impact the choice of therapy option in patients with intestinal lymphagiectasia.
Methods: The pre-surgical lymphoscintigraphy images from 32 patients with intestinal lymphagiectasia were retrospectively reviewed. All of the patient underwent post-scan thoracic duct decompression surgery. We compared the tracer uptake pattern to both the degree of the improvement of serum albumin level post-surgery and the size of the pre-surgical thoracic duct which was determined by sonography.
Results: Among all of 32 patients, 21 patients had focal abnormal activity in the left subclavian-jugular venous angle on lymphoscintigraphy while 11 did not. The average pre-surgery diameter of thoracic duct in those with abnormal activity in the left subclavian-jugular venous angle was 2.32±1.26 mm while it was 1.45±0.78 mm in those without such activity. More importantly, the average post-surgery serum albumin level significantly increased to 32.08±7.55g/L (p < 0.01) from pre-surgery level of 23.72±6.89 g/L in patients with abnormal activity in the left subclavian-jugular venous angle on lymphoscintigraphy. In contrast, for those patients without abnormal activity in the left subclavian-jugular venous angle, the average post-surgical serum level was 25.73±5.69 g/L, which was essentially not changed from pre-surgery level of 25.37±9.46g/L.
Conclusions: Abnormal activity in the subclavian-jugular venous angle on lymphoscintigraphy should be considered as one of criteria in determining the suitability of having thoracic duct decompression surgery in patients with Intestinal Lymphangiectasia.