Our Friday afternoon problem today came from HDU where they have a guy
with strawberry milkshake in his lungs and peritoneum. The chap in
question is recovering, or trying to, after repair of an abdominal
aortic aneurysm. The question is whether this is chyle from lymphatics
ruptured during surgery or the enteral feed which has somehow found its
way unintended through the gut perhaps through an eroding NG tube. They
have put some dye down the tube and it has stayed in the gut as far as
they can tell. The fluid, on standing, has a creamy top layer, middle
layer of faint haziness and red cell layer at the bottom. The protein
content (25 g/l) is not too far from that of chyle (20 g/l) but also not
that far from that of the feed (40 g/l). Almost certainly, after
rolling around the peritoneal cavity , the feed, if that is what it is,
will have changed due to slow "dialysis" against blood, so I can't rely
on the content of the native feed being similar to that which has been
sitting in the peritoneum.
The definitive test is probably Apo B48 content but we don't do that at
weekends (or ever !).
My prejudice is that this is chyle.
Any ideas for easy tests.
Trevor
Dr. T.A. Gray
Department of Clinical Chemistry
Northern General Hospital
Sheffield S5 7AU
0114 271 4309
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