Acute Appendicitis Together with Chylous Ascites: Is It a Coincidence?

Abstract

Acute chylous ascites is a rarely seen clinical picture, therefore, examination findings are often confused with acute appendicitis. To the best of our knowledge, there is no publication to date showing the occurrence of them together. This study presents the treatment plan for a 25-year-old male patient with both acute chylous ascites and appendicitis. Surgical findings were retrocaecal appendicitis, evident lymphangiectasia in the proximal segment of jejunum, and approximately 3 lt of chylous fluid. An appendectomy was performed and drainage was applied. Low-fat total parenteral nutrition (TPN) and octreotide treatment were administered for 7 days postoperatively. We also present a general review of some studies on chylous ascites, which have been published in the English language medical literature since 1910.

Two Cases of Atraumatic Chylous Ascites Characterized by Hypotriglyceridemia and Partially Managed with an Oral Fat-Free Elemental Diet

“…TGs ingested from meals are absorbed from the small intestine and ow into the portal vein via the lymph duct. However, if the lymphatic vessels in the abdominal cavity rupture and if TGs and lymph leak into the abdominal cavity from the collapsed site, chylous ascites occurs [1,2,10,11]. If le untreated, the patient's general condition may deteriorate due to malnutrition and reduction of immunity.…”

Spontaneous chylous ascites, chylomediastinum and bilateral chylothoraces encountered during laparoscopic incarcerated paraesophageal hernia repair

“…A high-protein and a low-fat diet with middle-chain fatty acids has proved successful [ 1 ]. Numerous case reports have endorsed pharmacotherapy such as octreotide and somatostatin either alone or in combination with total parenteral nutrition in managing a refractory chyle leak [ 1 , 2 , 9 ]. In cases of chylothorax, pleuro-peritoneal shunts or chest tubes are found to be useful, especially if severe dyspnea is present [ 10 ].…”

“…Left untreated, it can lead to nutritional deficiency and in some cases immunosuppression [ 1 ]. In rare cases, patients presenting emergently with volvulus or appendicitis have incidentally been found to have chylous ascites upon surgical exploration [ 2 – 4 ]. Paraesophageal hernia can present acutely with gastric obstruction or strangulation at an estimated incidence of 1.2% per patient per year, the treatment for which involves laparoscopic or open hernia reduction, resection of the hernia sac, repair of the hiatal defect and fundoplication [ 5 ].…”

Acute chylous ascites mimicking appendicitis

“…Chylous ascites typically presents as progressive and painless distension over weeks and months, and the majority of cases are diagnosed upon paracentesis. A lymphangiography or lymphoscintigraphy is often helpful to demonstrate the anatomical location of the leak, or in recurrent cases, the presence of any fistulas …”

“…Somatostatin analogues have also been proven to be effective in reducing lymphatic leakage. The underlying cause should be investigated and corrected to achieve complete resolution …”