lymphatic system
Trauma of the cheliferous vessels
Diseases of the cheliferous vessels
The cheliferous vessels are small lymphatic vessels that absorb fats (kilo) in the small intestine. Each cheliferouscapillary flows into a lymphatic duct of greater calibre. The appearance of the kilo is milky. Due to the high content of chylomicrons, corpuscles contain fats based on long-chain triglycerides.
Diseases of the cheliferousvessels are generally congenital and manifest from the first years of life. Theseare rare diseases, which affect the kilo cistern, the central reservoir below the diaphragmatic dome (also known as cisterna chyli or Aselli-Peequet) and/or the thoracic duct and involve the accumulation of kilo (the lymph generated in the digestive phase inside the small intestine)in organs or anatomical spaces (such as the abdomen and/or chest) where, however, it should not be found.
The causes of diseases of the cheliferous vessels
In most cases, the disease is caused by the alteration of the anatomical structure of the intestinal lymphatic system along its path from the intestine to the chyli cistern and the thoracic duct. This malformation considerably hinders the correct drainage of the lymphatic collectors located along the wall of the small intestine, which is filled with a kilo and dilates. A causa della posizione retro e/o peritoneale, può verificarsi la rottura di questi vasi linfatici. Their rupture involves the loss and release of the kilo, which can thus pour into the peritoneal cavity and/or into the thoracic cavity.
The traumas of the cheliferous vessels
Trauma to the cheliferous system can be the consequence of two types of injury:
Closed trauma
there is no interruption of the integuments or continuity between the body’s internal and external environment. Thewall of the via cheliferous is torn or dissected;
Open trauma
The force of the trauma causes laceration, disruption and separation of tissues and the cheliferous pathway can be completely broken.
In closed traumas, collections of lymph of different types are formed, sometimes able to self-eliminate or reabsorb. However,there aremore serious cases in which an infection can develop from the possible evolution even in the abscess. Furthermore, when these traumas of the lymphatic vessels are associatedwith lymphangitis, they can trigger persistent oedema due to kilo-gravitational refluxwhich also extends to the external genitals and the lower limbs.
On the other hand, whenthe trauma is open, there is an external loss of lymph (lymphorrhagia, the extent of which varies according to the area affected by the lesion: if the lymphatic vessels are at low pressure it will be minimal, while the loss can become persistent with pressure increase) and the best conditions are created for an infection.
Treatments for diseases of the cheliferous vessels
Faced with the most acute cases, specialists may deem surgery necessary, the type of which is commensurate with the extent of the lesion, its anatomical site and its extension. The different possible surgical procedures include:
The drainage of the chyloperitoneum (or chylous ascites, effusion of kilo in the peritoneal cavity)% of the chylothorax (if the effusion involves one or both pleural cavities);
The removal of chylous cysts or malformed or dysplastic chilo lymphangiectasia;
The ligatures of the dysplastic and abnormally dilated chyliferous lymphatic collectors
In the initial and more contained stages, however, an ad hoc one can certainly help aimed not only at limiting fats based on long-chain triglycerides (typical of the kilo) but also at controlling metabolism. Sometimes, however, when the disease is at a more advanced stage, it may be useful to reduce the amount of kilo produced in the intestine, resorting to the administration of nutrients directly into the blood (NPT, total parenteral nutrition).
