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Olaru A, Venkatachalapathy SV, James M, Martinez-Calle N. A case of idiopathic chylous ascites. Oxf Med Case Reports 2023; 2023:omad009. [PMID: 36860959 PMCID: PMC9969818 DOI: 10.1093/omcr/omad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/01/2023] [Accepted: 01/03/2023] [Indexed: 03/03/2023] Open
Abstract
Chylous ascites is a rare condition found in 1 in 20 000 patients admitted to hospital with abdominal distention. It is caused by a limited number of pathologies but can, in rare situations, be idiopathic. Its management is difficult and usually involves correcting the primary pathology, making idiopathic chylous ascites particularly difficult to manage. We present a case of idiopathic chylous ascites extensively investigated over a period of several years. An incidental finding of B cell lymphoma was initially suspected to have been the primary cause of the ascites; however, after successful treatment of this condition, the patient's ascites did not resolve. Diagnostic difficulties and management are discussed and an overview of the diagnostic process is outlined through this case.
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Affiliation(s)
- Adina Olaru
- Correspondence address. Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Derby Road, Nottingham NG2 7UH, UK. Tel: 0115 924 9924; E-mail:
| | - Suresh V Venkatachalapathy
- Nottingham Digestive Diseases Centre (NDDC) and National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre (BRC), Nottingham University and Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham, UK
| | - Martin James
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre (BRC), Nottingham University and Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham, UK
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2
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Wabada S, Ibrahim HA, Dada BJ, Zanna AU, Muhammed A, Mustapha B. Management of chylous ascites with surgery and frusemide in a new born. Afr J Paediatr Surg 2022; 19:192-195. [PMID: 35775526 PMCID: PMC9290358 DOI: 10.4103/ajps.ajps_59_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chylous ascites is the accumulation of milky fat-rich chyle in the peritoneal cavity. It is a rare condition in children. Congenital malformations of the lymphatic vascular channel are the predominant cause in children. Diagnosis is often confirmed by paracentesis of the chylous ascitic fluid. Treatment is generally conservative except in rare refractory cases that surgery is required for closure of the leak site or excision of the lymphatic cyst. Here is a report on the management of chylous ascites in a 6-h-old girl presenting in acute respiratory distress with acute abdominal distention due rapid increase in chylous ascitic fluid volume that was managed with surgery and frusemide.
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Affiliation(s)
- Samuel Wabada
- Department of Surgery, Paediatric Surgery Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Halima Abubakar Ibrahim
- Department of Paediatrics, Neonatology Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Bisuma Joel Dada
- Department of Paediatrics, Neonatology Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Aisha Umaryyrah Zanna
- Department of Surgery, Paediatric Surgery Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Abdulmajeed Muhammed
- Department of Surgery, Paediatric Surgery Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Bello Mustapha
- Department of Paediatrics, Neonatology Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
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Rashid R, Shafi Ahmed S, Mahmud S. Congenital Chylous Ascites: A Rare Cause of Infantile Ascites Treated With MCT-Based Diet and Octreotide. JPGN REPORTS 2022; 3:e149. [PMID: 37168766 PMCID: PMC10158395 DOI: 10.1097/pg9.0000000000000149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/03/2021] [Indexed: 05/13/2023]
Abstract
Congenital chylous ascites (CCAs) are a rare disease that results from the accumulation of chylomicron-rich lymphatic fluid within the peritoneal cavity due to maldevelopment of the intra-abdominal lymphatic system. Medium-chain triglyceride (MCT)-based diet, total parenteral nutrition (TPN), and repeated paracentesis are considered supportive management for CCA. Cases unresponsive to conservative treatment usually require surgical intervention. We report a case of CCA in a premature neonate treated successfully with intravenous infusion of octreotide (synthetic somatostatin analog), after failing to respond to supportive therapies. Due to the lack of standards in diagnosis and treatment, this disease constitutes a medical challenge, and individual therapy seems to be noteworthy.
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Affiliation(s)
- Rafia Rashid
- From the Department of Paediatric Gastroenterology, Hepatology & Nutrition, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh
| | - Syed Shafi Ahmed
- From the Department of Paediatric Gastroenterology, Hepatology & Nutrition, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh
| | - Salahuddin Mahmud
- From the Department of Paediatric Gastroenterology, Hepatology & Nutrition, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh
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Ermakov IV, Kolygin AV, Gasanov MM, Yudin IV, Goncharova NN, Sazhin AV. [Spontaneous diffuse chylous peritonitis during pregnancy]. Khirurgiia (Mosk) 2019:100-105. [PMID: 31825349 DOI: 10.17116/hirurgia2019121100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Spontaneous chylous peritonitis during pregnancy is a rare disease. Only a few publications are currently devoted to this problem. The authors reported successful treatment of a patient with spontaneous chylous peritonitis in the first trimester of pregnancy. Moreover, etiology, epidemiology, pathophysiology, diagnosis and treatment of patients with spontaneous chylous peritonitis and chiloperitoneum are analyzed. The authors consider laparoscopy as a safe and efficient method of treatment of patients with spontaneous chylous peritonitis including pregnant women.
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Affiliation(s)
- I V Ermakov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Kolygin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M M Gasanov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - I V Yudin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - N N Goncharova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Sazhin
- Pirogov Russian National Research Medical University, Moscow, Russia
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Kostov S, Yordanov A, Slavchev S, Strashilov S, Dzhenkov D. First Case of Chylous Ascites after Laparoscopic Myomectomy: A Case Report with a Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E624. [PMID: 31547593 PMCID: PMC6843166 DOI: 10.3390/medicina55100624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 12/12/2022]
Abstract
Introduction: Chylous ascites is a rare form of ascites characterized by milk-like peritoneal fluid, rich in triglycerides. Clinical signs and symptoms include abdominal distention, pain, nausea, and vomiting. In gynecology, the most common cause for its occurrence is lymph dissection leading to impairment of major lymphatic vessels. There are only a few reported cases of chylous ascites arising after operations for benign diseases. Case report: We report a case of a 46-year-old female patient, who underwent laparoscopy for a myomatous node with chylous ascites occurring on post-surgery Day 2. The ascites was conservatively managed. The exact cause of the chyloperitonitis could not be determined. Conclusion: Although extremely rarely, chylous ascites may also occur in operative interventions for benign diseases in gynecological surgery.
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Affiliation(s)
- Stoyan Kostov
- Department of Gynecology, Medical University Varna, 9000 Varna, Bulgaria.
| | - Angel Yordanov
- Department of Gynecologic Oncology, Medical University Pleven, 5800 Pleven, Bulgaria.
| | - Stanislav Slavchev
- Department of Gynecology, Medical University Varna, 9000 Varna, Bulgaria.
| | - Strahil Strashilov
- Department of Plastic Restorative, Reconstructive and Aesthetic Surgery, Medical University Pleven, 5800 Pleven, Bulgaria.
| | - Deyan Dzhenkov
- Department of General and Clinical pathology, Forensic Medicine and Deontology, Medical University Varna, 9002 Varna, Bulgaria.
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Brown S, Abana CO, Hammad H, Brown A, Mhlanga J, Binder C, Nabavizadeh N, Thomas C, Mitin T, Gilbert EW. Low-Dose Radiation Therapy is an Effective Treatment for Refractory Postoperative Chylous Ascites: A Case Report. Pract Radiat Oncol 2019; 9:153-157. [DOI: 10.1016/j.prro.2018.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/20/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022]
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Idiopathic chylous ascites in a patient with HIV infection: response to total parenteral nutrition and octreotide therapy. Clin J Gastroenterol 2018; 11:235-239. [PMID: 29427281 DOI: 10.1007/s12328-018-0832-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
The authors describe a 47-year-old man infected with human immunodeficiency virus admitted for ascites and weight loss. Ascitic fluid analysis revealed chylous ascites (triglycerides 444 mg/dl) with negative microbiological tests. Neoplasia, cardiac disease and liver cirrhosis were excluded after an extensive diagnostic workout. Exploratory laparotomy with tissue sampling did not clarify ascites etiology. During hospital admission, patient status gradually deteriorated, severe malnutrition developed and ascites became refractory to diuretics. Total parenteral nutrition and octreotide therapy were started and maintained for 3 weeks with ascites resolution and no relapse after oral diet resumption. Chylous ascites is a rare entity with several causes that compromise intra-abdominal lymphatic drainage. This case illustrates the difficulty in establishing etiology in some patients and the effectiveness of total parenteral nutrition plus octreotide therapy in idiopathic chylous ascites in HIV-infected patients.
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Wu X, Vega M, Swartz SJ, Michael M. Milky appearance of peritoneal fluid in a neonate on peritoneal dialysis due to end-stage renal disease: Answers. Pediatr Nephrol 2018; 33:73-76. [PMID: 28283762 DOI: 10.1007/s00467-017-3633-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Xiaoyan Wu
- Renal Section, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, 1102 Bates Avenue, Suite 245, Houston, TX, 77030, USA
| | - Molly Vega
- Renal Section, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, 1102 Bates Avenue, Suite 245, Houston, TX, 77030, USA
| | - Sarah J Swartz
- Renal Section, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, 1102 Bates Avenue, Suite 245, Houston, TX, 77030, USA
| | - Mini Michael
- Renal Section, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, 1102 Bates Avenue, Suite 245, Houston, TX, 77030, USA.
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Sakamoto A, Kamada Y, Kotani S, Yamada K, Kimata Y, Hiramatsu Y. In vitro fertilization and pregnancy management in a woman with acquired idiopathic chylous ascites. J Obstet Gynaecol Res 2017; 43:1773-1777. [PMID: 28737271 DOI: 10.1111/jog.13434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/12/2017] [Accepted: 05/21/2017] [Indexed: 11/28/2022]
Abstract
Acquired idiopathic chylous ascites is extremely rare in women of reproductive age. This is the first report describing successful infertility and pregnancy management in a patient with idiopathic chylous ascites. A 23-year-old woman presented with abdominal distention and was diagnosed with idiopathic fluid collection. A lymphogram revealed lymphatic leakage from the right renal hilum. Lymphatic-venous anastomosis of the thoracic duct was performed thrice, but the chylous ascites persisted. In vitro fertilization was performed because natural conception was not possible. Just prior to oocyte retrieval, transvaginal drainage of ascites was performed. In total, nine blastocysts were obtained and cryopreserved. Single frozen embryo transfer was performed, including hormone replacement therapy. The patient became pregnant and the ascites spontaneously decreased as the pregnancy progressed, finally disappearing around gestational week 20. A healthy baby was delivered transvaginally. Ascites began to reaccumulate on post-partum day 1 and returned to the pre-pregnancy level within a month.
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Affiliation(s)
- Ai Sakamoto
- Department of Obstetrics and Gynecology, Okayama University Graduate Schools of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuhiko Kamada
- Department of Obstetrics and Gynecology, Okayama University Graduate Schools of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Sayoko Kotani
- Department of Obstetrics and Gynecology, Okayama University Graduate Schools of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kiyoshi Yamada
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate Schools of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshihiro Kimata
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate Schools of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuji Hiramatsu
- Department of Obstetrics and Gynecology, Okayama University Graduate Schools of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Ultrasound-Guided Intranodal Lymphangiography With Ethiodized Oil to Treat Chylous Ascites. ACG Case Rep J 2016; 3:e95. [PMID: 27807557 PMCID: PMC5062668 DOI: 10.14309/crj.2016.68] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/29/2016] [Indexed: 12/23/2022] Open
Abstract
A 70-year-old man presented with abdominal distention and pain. A diagnosis of chylous ascites (CA) was made by abdominal paracentesis. Conservative treatment had failed to control CA; therefore, ultrasound-guided intranodal lymphangiography (UIL) with Lipiodol was performed. No obvious Lipiodol leakage was observed in the follow-up computed tomography; however, the persistent abdominal pain was significantly reduced within a day, and CA was resolved within 3 days. We present successful treatment of CA using UIL with Lipiodol. The combination of the technique of UIL and therapeutic lymphangiography with Lipiodol is a promising minimally invasive treatment option for CA.
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Ünlüsoy Aksu A, Demirtaş Z, Eğritaş Gürkan Ö, Dalgıç B, Sözen H, Dalgıç A. Chylous ascites after a living-donor liver graft, effectively treated in a child with octreotide. EXP CLIN TRANSPLANT 2014; 12 Suppl 1:173-174. [PMID: 24635821 DOI: 10.6002/ect.25liver.p48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Chylous ascites after a liver transplant is a rare complication of surgery. We report a 11-month-old girl with biliary atresia who was presented with chylous ascites after a liver transplant. On the seventh day after surgery, while being fed, chylous ascites was observed. Besides fasting and diuretics, total parenteral nutrition and somatostatin analogue (octreotide) were initiated. Chylous ascites resolved in 3 weeks. Abdominal distention recurred 1 week later; fasting and total parenteral nutrition, combined with octreotide, were administered again for 2 more weeks. Thereafter, enteral feeding was started without any complications.
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Affiliation(s)
- Aysel Ünlüsoy Aksu
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Gazi University, Ankara, Turkey
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Chylous Ascites: Evaluation and Management. ISRN HEPATOLOGY 2014; 2014:240473. [PMID: 27335837 PMCID: PMC4890871 DOI: 10.1155/2014/240473] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 12/19/2013] [Indexed: 02/07/2023]
Abstract
Chylous ascites refers to the accumulation of lipid-rich lymph in the peritoneal cavity due to disruption of the lymphatic system secondary to traumatic injury or obstruction. 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 trauma are commonest in children. The presence of a milky, creamy appearing ascitic fluid with triglyceride content above 200 mg/dL is diagnostic, and, in the majority of cases, unless there is a strong suspicion of malignancy, further investigations are not required in patients with cirrhosis. If an underlying cause is identified, targeted therapy is possible, but most cases will be treated conservatively, with dietary support including high-protein and low-fat diets supplemented with medium-chain triglycerides, therapeutic paracentesis, total parenteral nutrition, and somatostatins. Rarely, resistant cases have been treated by transjugular intrahepatic portosystemic shunt, surgical exploration, or peritoneovenous shunt.
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Lee YD, Lee YH, Choi HS. Chylous Ascites in a Patient with Sepsis Caused by Bilateral Pneumonia. Korean J Crit Care Med 2014. [DOI: 10.4266/kjccm.2014.29.3.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Yong Dae Lee
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Young Hyun Lee
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Hye Sook Choi
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
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Yilmaz M, Akbulut S, Isik B, Ara C, Ozdemir F, Aydin C, Kayaalp C, Yilmaz S. Chylous ascites after liver transplantation: incidence and risk factors. Liver Transpl 2012; 18:1046-52. [PMID: 22639428 DOI: 10.1002/lt.23476] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In this study, we evaluated the diagnosis, epidemiology, risk factors, and treatment of chylous ascites developing after liver transplantation (LT). Between 2002 and 2011, LT was performed 693 times in 631 patients at our clinic. One-hundred fifteen of these patients were excluded for reasons such as retransplantation, early postoperative mortality, and insufficient data. Chylous ascites developed after LT (mean ± SD = 8.0 ± 3.2 days, range = 5-17 days) in 24 of the 516 patients included in this study. Using univariate and multivariate analyses, we examined whether the following were risk factors for developing chylous ascites: age, sex, body mass index, graft-to-recipient weight ratio, Model for End-Stage Liver Disease score, vena cava cross-clamping time, total operation time, Child-Pugh classification, sodium level, portal vein thrombosis or ascites before transplantation, donor type, albumin level, and perihepatic dissection technique [LigaSure vessel sealing system (LVSS) versus conventional suture ligation]. According to a univariate analysis, a low albumin level (P = 0.04), the presence of ascites before transplantation (P = 0.03), and the use of LVSS for perihepatic dissection (P < 0.01) were risk factors for developing chylous ascites. According to a multivariate Cox proportional hazards model, the presence of pretransplant ascites [P = 0.04, hazard ratio (HR) = 2.8, 95% confidence interval (CI) = 1.1-13.5] and the use of LVSS for perihepatic dissection (P = 0.01, HR = 5.4, 95% CI = 1.5-34.4) were independent risk factors. In conclusion, the presence of preoperative ascites and the use of LVSS for perihepatic dissection are independent risk factors for the formation of chylous ascites. To our knowledge, this study is the most extensive examination of the development of chylous ascites. Nevertheless, our results should be supported by new prospective trials.
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Affiliation(s)
- Mehmet Yilmaz
- Division of Liver Transplantation, Department of Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey.
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