Chylous Ascites

Abstract

Context:Chylous ascites is the accumulation of milky chyle in the peritoneal cavity. Chylous ascites has been reported after surgeries like abdominal aortic aneurysm repair, radical gastrectomy, duodenectomy, nephrectomy and Wilm's tumor resection. Our literature search did not reveal any reports of chylous ascites after a gastric ulcer resection. We report about an elderly woman with a rare complication of chylous ascites after an emergent surgery for a perforated gastric ulcer.Case Report:A 70-year-old woman developed sudden respiratory distress on 5th post-operative day after an elective C3-C7 cervical discectomy and fusion. Her past medical history was significant for cervical spondylosis. The Computed Tomography (CT) scan of the chest revealed air under the diaphragm suspicious for hollow viscus perforation. She underwent an emergent surgery for drainage of hematoma in the neck along with an emergent laparotomy to repair a large perforated gastric ulcer distal to the gastro-esophageal junction. The patient had worsening of abdominal distention on 4th post-operative day. The CT scan of abdomen showed fluid collection in the abdomen. The abdominal drain revealed large amount of serous milky fluid at the rate of 1500 ml per day. The fluid analysis showed that the triglyceride level was 170 mg/dl and cholesterol level was 15 mg/dl. The fluid cultures did not grow any organism. She responded to treatment with octreotide and a diet of medium chain triglyceride oil.Conclusion:Any obstruction or damage to the lymphatic channels results in chylous ascites. Lymphomas, metastatic malignancies, and abdominal surgeries commonly cause chylous ascites. Ascitic fluid triglyceride level greater than 110 mg/dl is diagnostic of chylous ascites. Chylous ascites is a rare complication of a peptic ulcer resection which can be managed effectively with octreotide.

The Use of Indocyanin Green for Peroperative Diagnostic of Chylous Ascites and Autologous Tissue Glue (Vivostat) for the Treatment

“…Jednou z možností, jak dané místo peroperačně lokalizovat, je využití fluorescenční látky zvané indocy aninová zeleň (indocyanin green -ICG), která se recentně používá např. k ob jektivizaci tkáňového prokrvení nebo lymfografii [5].…”

Chylous Ascites Following Open Abdominal Aortic Aneurysm Repair: An Unusual Complication

“…Triglyceride levels are greater than 200 mg/dL. 6 Protein content varies between 2.5 and 7 g/dL, with a mean of 3.7 g/dL, 7 while the serum/chylous albumin gradient is less than 1.1.…”

“…Cholesterol level is typically low, 7 and glucose content is less than 100 mg/dL. Computerized tomography (CT) is an important diagnostic tool, although it has low specificity.…”

Management of Chylous Ascites with Octreotide in a Bangladeshi Child: A Case Report

“…2,3 Dysplastic lymphatic vessels, both hypoand hyperplastic ones favor lymphatic leak-age in the mechanism of increasing pressure in the lym-phatic system, resulting lymphatic congestion. 4,5 Delayed maturation of lymphatic vessels leading to abnormal structure of their walls, also results in lymphatic leakage to the peritoneal cavity. Developmental disorders of lymphatic vessels constitute the main cause of congenital chylous ascites found in newborns.…”