Ascites is the abnormal buildup of fluid in the abdomen. Worldwide, abdominal malignancy, cirrhosis, and tuberculosis are the commonest causes of ca in adults, the latter being most prevalent in developing countries, whereas congenital abnormalities of the lymphatic system and. This usually occurs due to trauma and rupture of the lymphatics or increased peritoneal lymphatic pressure secondary to obstruction. Chronic relapsing pancreatitis with extensive subacute peritonitis and chronic recurrent massive chylous ascites. Ascites in a 42yearold woman cleveland clinic journal. Diagnosis and management of primary chylous ascites journal of. Diagnosis and management of congenital neonatal chylous. Chylous ascites has been reported after surgeries like abdominal aortic aneurysm repair, radical gastrectomy, duodenectomy, nephrectomy and wilms tumor resection. Chylous ascites may not resolve quickly and a trial of up to 4 weeks should be made before it is decided that tpn has been unsuccessful in treating the ascites.
The authors report a case of chylous ascites in a two month old boy with massive ascites. Multiple causes have been described, with the most common causes being malignancy hepatoma, small bowel lymphoma, small bowel angiosarcoma, and retroperitoneal lymphoma, cirrhosis. Etiologically it is due to a disruption of the lymphatic system, most commonly obstructive due to a mass or traumatic which maybe iatrogenic. Sep 19, 2019 chylous ascites is an uncommon clinical condition that occurs as a result of disruption of the abdominal lymphatics. Even though the occurrence of chylous ascites is a well recognized complication of pancreatitis, 1 x 1 gambill, ee, walters, w, and scanlon, pn. Symptoms may include increased abdominal size, increased weight, abdominal discomfort, and shortness of breath. Chylous ascites observed during catheter insertion. Eight patients were diagnosed with chylous ascites, on the basis of laboratory findings on. Chylous ascites associated with intestinal obstruction. Entering on the subject of chylous ascites, it appears necessary that we consider both chylous and chyloid effusions into the peritoneal cavity, since these two forms of ascites are dependent on entirely different pathologic processes.
Octreotide is a crucial drug used for treating patients with chylous ascites. Diagnosis and management of primary chylous ascites. The denver ascites shunt is a peritoneovenous shunting system that can help relieve symptoms of ascitic fluid buildup. Chylous ascites is a rare cause of ascites resulting from the accumulation of lymph in the abdominal cavity. Chyle is a thick, milky substance, which consists of triglycerides and fatty deposits which are absorbed by the small intestine. Neonatal chylous ascites successfully treated with mctbased. Chylous ascites observed during catheter insertion imai. An unusual case of urinary ascites presenting as postoperative acute oliguric renal failure. Chylous ascites and chylothorax due to the existence of. He was managed with repeated therapeutic paracentesis and skimmed milk feeding. Technically, it is more than 25 ml of fluid in the peritoneal cavity. Successful laparoscopic management of chylous ascites. Chylous ascites is a wellknown complication of severe nephrotic syndrome. Chylous ascites clinical kidney journal oxford academic.
Blunt trauma to the abdomen, cancer, liver cirrhosis, and surgical procedures can all lead to this condition. A 59yearold woman with hypertension presented to the emergency. Feb 03, 2014 chylous ascites ca is an uncommon form of ascites, defined as the leakage of the lipidrich lymph into the peritoneal cavity. Chylous ascites secondary to cirrhosis of the liver. Damage or obstruction to the lymphatic system or one of its tributaries produces ascites with a turbid or milky appearance from the high triglyceride content 1. Chylous ascites is the accumulation of milky chyle in the peritoneal cavity. A chyle fistula occurs when defects of lymphatic vessels result in leakage of lymphatic fluid, typically accumulating in the thoracic pleural or abdominal peritoneal cavities, leading to a chylous pleural effusion chylothorax or chylous ascites, respectively. By continuing to use our website, you are agreeing to our use of cookies. However i would like to make some comments on the management of the given case.
View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Forty cases of pediatric chylous ascites have been reported since 1960, with an age range from birth to 18 years. Chylous ascites is the extravasation of milky chyle into the peritoneal cavity. Association of down syndrome with primary chylous ascites has been well documented in. There have been very few previous reports of calcium channel blockers ccbs as potential causes of chylous ascites, and most of the patients were undergoing peritoneal dialysis. The underlying etiologies for ca have been classified as. Eosinophilic gastroenteritis ege is a rare condition and the diagnosis of subserosal ege is challenging due to its nonspecific symptoms and signs and frequently nondiagnostic biopsy on gastrointestinal endoscopy. Chylous ascites ca is a rare form of ascites that results from the leakage of lipidrich lymph into the peritoneal cavity. The underlying etiologies for ca have been classified as traumatic, congenital, infectious, neoplastic, postoperative, cirrhotic or. Thus, this thesis is designed to determine the effects of octreotide on patients with chylous ascites after liver cirrhosis. Chylous ascites refers to the accumulation of lipidrich lymph in the peritoneal cavity due to disruption of the lymphatic system secondary to. Jan 21, 2019 chylous ascites is a rare condition where there is leakage of chyle, which is a natural body fluid, into the abdominal cavity from a duct in the lymphatic system. A marked improvement was resulted in clinical symptoms and laboratory findings at the time of discharge to be followedup at the outpatient service. Chylous ascites refers to a leakage of a natural bodily fluid called chyle into the abdominal cavity from a duct in the lymphatic system.
Chylous ascites is an uncommon finding with a reported incidence of approximately 1 per 20,000 admissions at a large universitybased hospital over a twodecade. Chylous ascites, defined as a lipidrich fluid accumulation in the peritoneal cavity, is a rare pathology of the lymphatic system and is a very rare cause of acute abdomen. Diagnosis and management of congenital neonatal chylous ascites article pdf available in hippokratia 162. Pointofcare ultrasound performed in the emergency department allowed for rapid diagnosis of a large amount of free intraabdominal fluid, which together with the physical findings, prompted emergent operative exploration revealing chylous ascites. Review the diagnostic workup in patients with ascites. Chylous ascites is a milkyappearing peritoneal fluid that is rich in triglycerides. I read with interest the article on congenital chylous ascites and lymphedema in downssyndrome published in nov. A high neutrophil count in the ascitic fluid and a negative culture are also consistent with chylous ascites. Chylothorax is associated with significant morbidity and mortality if left untreated. Primary chylous ascites can be congenital or may appear later in life, depending on the patients genetic complexity and on the environmental effects. Incidental chylous ascites at the time of cesarean section.
Congenital chylous ascites journal of perinatology. It has different etiologies that interrupt the lymphatic. Worldwide, abdomin al malignancy, cirrhosis, and tuberculosis are the commonest. Treatment is aimed at resolving the underlying cause of the ascites.
We present a 4weekold neonate with acute onset of bloody stools and abdominal distention. Chylothorax is the accumulation of chyle in the pleural space. Chylothorax can be due to several etiologies, among which malignancy and surgical trauma are the commonest. Octreotide, a somatostatin analogue, has been used for the treatment of cca, but always after a failed conservative approach with fasting, total parenteral nutrition tpn or medium. Chylous ascites also known as chyloperitoneum is defined as the abnormal intraperitoneal accumulation of milky lymphatic fluid with a triglyceride level 110 mgdl 1. Visit the orphanet disease page for more resources. Previous abdominal surgery, pancreatitis, trauma and retroperitoneal lymphoma are among the main causes. Chylous ascites genetic and rare diseases information.
Our literature search did not reveal any reports of chylous ascites after a gastric ulcer resection. It is usually milky in appearance and high in triglyceride content. Chylous ascites is an uncommon condition characterized by a white, milkyappearing peritoneal fluid, and is related to disruption of the lymphatic system from any cause. Successful management of congenital chylous ascites with. It is due to the presence of thoracic or intestinal lymph in the abdominal cavity. Pdf chylous ascites refers to the accumulation of lipidrich lymph in the peritoneal cavity due to. Chylous ascites refers to the accumulation of lipidrich lymph in the peritoneal cavity due to disruption of the lymphatic system secondary to traumatic injury or obstruction. Malignancy malignancy is a common cause of chylous ascites in adults, and lymphoma accounts for at least one half to one third of the cases according to a.
Chylous ascites is a type of ascites, the cause of which includes different factors, such as blunt trauma to the abdomen, cancer, liver cirrhosis and some surgical procedures. However, the coexistence of chylous ascites and chylothorax is rarely reported in adu we use cookies to enhance your experience on our website. It is a rare condition that can be caused by many different factors. The denver ascites shunt from carefusion is designed to give you and your patients an alternative to conventional therapy in managing retractable ascites. Chylous ascites and chylous pleural effusions probably occur at times with hereditary lymphedema, but this condition in its various forms is usually dominant. It is generally associated with diseases such as cancer, cirrhosis, inflammatory diseases, surgery, or trauma. The presenting signs and symptoms were secondary to abdominal distension in over 80% of cases. Chronic pancreatitis associated with chylous ascites simulating liver cirrhosis. Moreover, an existing clear ascitic fluid can turn chylous as a secondary event. Pdf chronic pancreatitis associated with chylous ascites. Chylous ascites associated with intestinal obstruction was first mentioned by mackman in 1967, and our present case is the first case report of chylous ascites occurring with a petersens hernia. It has multiple etiologies including trauma to the abdomen, malignancies, and intraperitoneal infections. Without treatment, a person can experience severe abdominal pain, nausea, and fever. Successful laparoscopic management of chylous ascites following laparoscopic radical nephrectomy article in international journal of urology 5.
As in our case, all previous cases were characterized by the presence of small bowel obstruction. Chylous ascites refers to the accumulation of lipidrich lymph in the peritoneal. Chylous ascites is a rare form of ascites caused by accumulation of lymph in the peritoneal cavity, usually due to intraabdominal malignancy, liver cirrhosis or abdominal surgery complications, and present with painless but progressive abdominal distension, dyspnea and weight gain. Congenital chylous ascites cca is a rare disease that results from maldevelopment of the intraabdominal lymphatic system. Chylous ascites is the extravasation of lymphatic fluid into the peritoneal cavity. A high triglyceride content in her ascitic fluid 150 mgdl is consistent with chylous ascites, which is seen in patients with previous abdominal surgery or with lymphatic obstruction due to malignancy. Marianna university school of medicine, kawasaki, japan. The chylous ascites was secondary to trauma, which included child abuse 19%, obstruction 27%, or lymphatic. An unusual case of postoperative ascites after cesarean. Few cases have been described and no gold standard treatment has been defined so far. It is distributed in accordance with the creative commons attribution non commercial cc bync 4.
Chylous ascites is characterized by the accumulation of a milky or creamy fluid rich in triglycerides in the abdominal cavity. Chylous ascites refers to the accumulation of lipidrich lymph in the peritoneal cavity due to disruption of the lymphatic system secondary to traumatic injury or. Malignancy, cirrhosis, and lymphatic disruption after abdominal surgery are leading causes in adults. Chylous ascites is the accumulation of triglyceriderich, free, milklike peritoneal fluid caused by the presence of intestinal lymph in the abdominal cavity. Damage or obstruction to the lymphatic system or one of its tributaries produces ascites with a turbid or milky appearance from the high triglyceride content.