Pdf chronic pancreatitis associated with chylous ascites. Chronic relapsing pancreatitis with extensive subacute peritonitis and chronic recurrent massive chylous ascites. Visit the orphanet disease page for more resources. Postoperative ascites of unknown origin after laparoscopic gynecologic surgery. Options for nutrition complications of his condition management include. The presenting signs and symptoms were secondary to abdominal distension in over 80% of cases.
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. Chylous ascites has been reported after surgeries like abdominal aortic aneurysm repair, radical gastrectomy, duodenectomy, nephrectomy and wilms tumor resection. As in our case, all previous cases were characterized by the presence of small bowel obstruction. 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 period. An unusual case of postoperative ascites after cesarean. However i would like to make some comments on the management of the given case. Moreover, an existing clear ascitic fluid can turn chylous as a secondary event. Chylous ascites is the extravasation of lymphatic fluid into the peritoneal cavity. Congenital chylous ascites journal of perinatology. 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.
Few cases have been described and no gold standard treatment has been defined so far. Sep 19, 2019 chylous ascites is an uncommon clinical condition that occurs as a result of disruption of the abdominal lymphatics. It has multiple etiologies including trauma to the abdomen, malignancies, and intraperitoneal infections. It is distributed in accordance with the creative commons attribution non commercial cc bync 4. Diagnosis of a chyle fistula may be accomplished by analysis of pleural. It is a rare condition that can be caused by many different factors. Malignancy, cirrhosis, and lymphatic disruption after abdominal surgery are leading causes in adults. However, the coexistence of chylous ascites and chylothorax is rarely reported in adu we use cookies to enhance your experience on our website.
Primary chylous ascites can be congenital or may appear later in life, depending on the patients genetic complexity and on the environmental effects. Eight patients were diagnosed with chylous ascites, on the basis of laboratory findings on. Chylous ascites is the accumulation of milky chyle in 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.
Previous abdominal surgery, pancreatitis, trauma and retroperitoneal lymphoma are among the main causes. Chylous ascites is a rare cause of ascites resulting from the accumulation of lymph in the abdominal cavity. 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. Chylous ascites ca is an uncommon form of ascites, defined as the leakage of the lipidrich lymph into the peritoneal cavity. Chylous ascites, defined by a triglyceride concentration of 110 mgdl 1. 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. Without treatment, a person can experience severe abdominal pain, nausea, and fever. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Blunt trauma to the abdomen, cancer, liver cirrhosis, and surgical procedures can all lead to this condition. Chylous ascites observed during catheter insertion imai. Symptoms may include increased abdominal size, increased weight, abdominal discomfort, and shortness of breath. Chylous ascites observed during catheter insertion.
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 and chylothorax due to the existence of. Successful management of congenital chylous ascites with. The denver ascites shunt is a peritoneovenous shunting system that can help relieve symptoms of ascitic fluid buildup. Marianna university school of medicine, kawasaki, japan. Diagnosis and management of congenital neonatal chylous ascites article pdf available in hippokratia 162. 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. 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. Review the diagnostic workup in patients with ascites. Octreotide is a crucial drug used for treating patients with chylous ascites.
It is due to the presence of thoracic or intestinal lymph in the abdominal cavity. This usually occurs due to trauma and rupture of the lymphatics or increased peritoneal lymphatic pressure secondary to obstruction. Chylous ascites associated with intestinal obstruction. 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. Diagnosis and management of congenital neonatal chylous. Chylothorax is associated with significant morbidity and mortality if left untreated. Chylous ascites clinical kidney journal oxford academic. We present a 4weekold neonate with acute onset of bloody stools and abdominal distention. The authors report a case of chylous ascites in a two month old boy with massive ascites. Worldwide, abdomin al malignancy, cirrhosis, and tuberculosis are the commonest. 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. 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. The chylous ascites was secondary to trauma, which included child abuse 19%, obstruction 27%, or lymphatic. Congenital chylous ascites cca is a rare disease that results from maldevelopment of the intraabdominal lymphatic system.
Diagnosis and management of primary chylous ascites. Chylous ascites is the extravasation of milky chyle into the peritoneal cavity. Successful laparoscopic management of chylous ascites following laparoscopic radical nephrectomy article in international journal of urology 5. A high neutrophil count in the ascitic fluid and a negative culture are also consistent with chylous ascites. Etiologically it is due to a disruption of the lymphatic system, most commonly obstructive due to a mass or traumatic which maybe iatrogenic. It is generally associated with diseases such as cancer, cirrhosis, inflammatory diseases, surgery, or trauma. Chylous ascites is a wellknown complication of severe nephrotic syndrome. Diagnosis and management of primary chylous ascites journal of. Successful laparoscopic management of chylous ascites. 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.
Multiple causes have been described, with the most common causes being malignancy hepatoma, small bowel lymphoma, small bowel angiosarcoma, and retroperitoneal lymphoma, cirrhosis. Thus, this thesis is designed to determine the effects of octreotide on patients with chylous ascites after liver cirrhosis. 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. 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. He was managed with repeated therapeutic paracentesis and skimmed milk feeding. Incidental chylous ascites at the time of cesarean section. I read with interest the article on congenital chylous ascites and lymphedema in downssyndrome published in nov. It is usually milky in appearance and high in triglyceride content. Ascites is the abnormal buildup of fluid in the abdomen. 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. 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 and chylous pleural effusions probably occur at times with hereditary lymphedema, but this condition in its various forms is usually dominant. The denver ascites shunt from carefusion is designed to give you and your patients an alternative to conventional therapy in managing retractable ascites. 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.
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. 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. Chylous ascites refers to the accumulation of lipidrich lymph in the peritoneal cavity due to disruption of the lymphatic system secondary to. Association of down syndrome with primary chylous ascites has been well documented in. 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. Pdf chylous ascites refers to the accumulation of lipidrich lymph in the peritoneal cavity due to. Chylous ascites refers to a leakage of a natural bodily fluid called chyle into the abdominal cavity from a duct in the lymphatic system. Our literature search did not reveal any reports of chylous ascites after a gastric ulcer resection. 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. The underlying etiologies for ca have been classified as traumatic, congenital, infectious, neoplastic, postoperative, cirrhotic or. Ascites in a 42yearold woman cleveland clinic journal.
Chyle is a thick, milky substance, which consists of triglycerides and fatty deposits which are absorbed by the small intestine. Chronic pancreatitis associated with chylous ascites simulating liver cirrhosis. 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. By continuing to use our website, you are agreeing to our use of cookies. Chylous ascites is the accumulation of triglyceriderich, free, milklike peritoneal fluid caused by the presence of intestinal lymph in the abdominal cavity. Chylous ascites is characterized by the accumulation of a milky or creamy fluid rich in triglycerides in the abdominal cavity. Complications can include spontaneous bacterial peritonitis in the developed world, the most common cause is liver cirrhosis. Chylous ascites refers to the accumulation of lipidrich lymph in the peritoneal. It has different etiologies that interrupt the lymphatic. A marked improvement was resulted in clinical symptoms and laboratory findings at the time of discharge to be followedup at the outpatient service.
Even though the occurrence of chylous ascites is a well recognized complication of pancreatitis, 1 x 1 gambill, ee, walters, w, and scanlon, pn. Treatment is aimed at resolving the underlying cause of the ascites. 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. Chylous ascites secondary to cirrhosis of the liver. Chylous ascites genetic and rare diseases information. Chylous ascites is a milkyappearing peritoneal fluid that is rich in triglycerides. Technically, it is more than 25 ml of fluid in the peritoneal cavity.
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