Chylous Ascites Associated with Acute Pancreatitis in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis

Abstract

We report on a case of chylous ascites associated with acute pancreatitis secondary to gallbladder stone disease, in a patient undergoing continuous ambulatory peritoneal dialysis. The initial clinical presentation was one of bacterial peritonitis, with later appearance of chylous peritoneal drainage. Diagnosis was suggested by abdominal computed tomography and confirmed by surgical exploration. We discuss the main diagnostic keys of peritoneal dialysis-associated pancreatitis and the possible etiologic role of this entity in chylous ascites of these patients.

Noninfectious Causes of Cloudy Peritoneal Dialysate

“…The most common cause of chylous peritoneal dialysate is lymphatic obstruction secondary to malignancy, in particular lymphoma (30). Acute pancreatitis may also cause chylous dialysate (33). The mechanism relating pancreatic inflammation with increased dialysate triglyceride content remains unknown; the swollen pancreas might impede lymphatic drainage by directly compressing the lymphatic channels as they converge on the cisterna chyli (34).…”

Cloudy Peritoneal Dialysate: It’s not Always Infection

“…The most common cause of chylous peritoneal dialysate is lymphatic obstruction secondary to malignancy, in particular lymphoma [12]. Acute pancreatitis may also cause chylous dialysate; the swollen pancreas might impede lymphatic drainage by directly compressing the lymphatic channels as they converge on the cisterna chili [15]. Superior vena cava syndrome has been reported to cause chylous peritoneal dialysate presumably by impairing lymphatic flow [16].…”

Fibroadhesive Form of Tuberculous Peritonitis: Chyloperitoneum in a Patient Undergoing Automated Peritoneal Dialysis

“…In the context of peritoneal dialysis, chylous ascites is a very infrequent complication [3,4], Although the cause of chylous ascites in patients on peritoneal dialysis remains frequently undetected [4], there are a few reports on the possible etiology. De Paula et al [7] reported a case with chylous ascites occurring 15 days after placement of a Tenckhoff catheter and initiation of dialysis.…”

“…They speculated that repeated mild trauma to the lymphatics by movement and peritoneal fibrosis could be the causes. Fontan et al [4] reported on chylous ascites associated with acute pancreatitis in a patient undergoing continuous ambulatory peritoneal dialysis. Diffuse in flammatory reaction can temporarily obliterate major channels of lymphatic drainage from the viscera; in addi tion, the retroperitoneal location of the pancreas and its proximity to the cisterna chyli and lumbar lymphatics possibly result in extension of the inflammatory process to these structures [1], Why chylous ascites developed in our patient?…”

“…Chylous ascites is an infrequent condition, most often resulting from mechanical obstruction of the thoracic duct, cistema chyli, or intestinal lymphatics [1,2], In adults, neoplasm and inflammatory processes are the pre dominant etiologic factors [3], Chylous ascites in associa tion with peritoneal dialysis is uncommon, and usually unrecognized [4].We describe a patient receiving auto mated peritoneal dialysis in whom chylous ascites ap peared temporarily during the course of tuberculous peri tonitis.…”