UNILATERAL CHYLOUS LYMPHEDEMA AND XANTHOMATOSIS: A STUDY OF FACTORS GOVERNING THE FLOW OF INTESTINAL LYMPH.

Abstract A description is given of a child suffering from reflux of small intestinal lymph into the subcutaneous tissues of the lower limb. The diagnosis was established by finding I 131 in the chylomicrons of the leg lymph following an oral dose of radioactive triolein and by observing compositional changes in the lymph lipids during the feeding of various fats. Lymphangiography revealed that valvular incompetence and areas of gross dilatation were present in the retroperitoneal, renal and leg lymphatics. The valvular lesion was considered to be congenital in origin. Experiments were undertaken to inhibit small intestinal lymph flow and so to reduce the degree of lymphedema. Significant changes in leg volume were effected by a fat-free diet, by salt deprivation and by feeding medium-chain fats, but the volume changes were small and thus of little therapeutic value. Appreciable clinical improvement resulted over a period of five months when the affected leg was elevated at night and placed in a tightly fitting elastic stocking during the day. It is suggested that this maneuver be given adequate trial before surgical correction is attempted.