Failure of Medium Chain Triglycerides in the Treatment of Persistent Chylous Ascites Secondary to Lymphosarcoma

Serum and chyle lipids during medium-chain triglyceride feeding in a child with chylothorax.

“…Small but significant amounts of both caprylic and capric acids were detected in increasing concentrations as the dietary intake of MCT increased. In this respect our findings are similar to those of Fernandes et al (1955) and supported by the electronmicroscopical studies of McKay et al (1967), but at variance with those of Hashim et al (1964) and Frank et al (1966) who did not detect any significant amount of medium-chain fatty acids in chyle or ascitic fluid during MCT feeding. Technical problems may contribute to the differences between the findings, the medium-chain triglycerides and fatty acids being water soluble and the methyl esters of the medium-chain fatty acids being highly volatile (I.…”

“…Because fatty acids with carbon chain lengths below 12 are absorbed almost wholly into the portal venous system, medium-chain triglycerides (MCT), which contain these shorter chain fatty acids, have been used in the treatment of chylothorax and chylous ascites (Fernandes, Van de Kamer, and Weijers, 1955;Hashim et al, 1964;Frank et al, 1966;Poley et al, 1967). In 3 of the 4 patients reported the volume of chylous fluid diminished; in all patients the concentration of lipid in the fluid decreased and only small quantities of mediumchain fatty acids were detected.…”

The Use of a Medium Chain Triglyceride Diet in Chyloperitoneum

“…There is only one report describing the use of an MCT diet in a patient with chylous ascites unrelated to congenital abnormalities of the lymphatics. In this adult with lymphosarcoma, dietary treatment failed to re- duce the volume of ascitic fluid, although this became serous rather than chylous (Frank, Kern, Franks, and Urban, 1966). In the patient to be described now, a child with tuberculosis and chyloperitoneum, we found that improvement of the latter coincided with the introduction of an MCT diet.…”

“…Chyloperitoneum usually results from obstruction of the thoracic duct, cysterna chyli or intestinal lymphatics (McCarthy and Organ, 1958). In adults, the underlying abnormality is most frequently neoplastic (Kelly and Butt, 1960) and other causes such as tratuma, tuberculosis and congenital abnormalities of the lymphatics are unusual (Nix, Albert, Dugas and Wendt, 1957).…”

Chylous Ascites: A Rare Complication of Radical Gastrectomy

“…Medium chain triglycerides (MCT) are absorbed directly into the portal venous system, bypassing the lymph system and reducing the amount and flow of chyle. Initial studies using elemental feeds using MCT were very encouraging, however several failures have also been reported 16‐19 . TPN is used as a means of achieving complete bowel rest which allows surgically traumatised lymph vessels to heal.…”