Idiopathic chylous ascites simulating acute appendicitis: A case report and literature review

Abstract

HighlightsA rare case of idiopathic chylous ascites in a young female is reported. The management and outcome with long term follow up were discussed.The variable nature of presentation of chylous ascites necessitates high index of suspicion. Diagnosis predominately requires abdominal paracentesis and triglyceride levels in the ascetic fluid obtained.Management of idiopathic chylous ascites is mostly conservative, once the diagnosis is established. The treatment may include low fat diet and occasional somatostatin use.Further research is mandatory as there is a significant rise in reported cases with no standardized guidelines for management.

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

“…Most cases of chylous ascites occur a er surgery [1], and the proportion of nonsurgical cases is low. It is said that malignancies (25%), liver cirrhosis (16%), and tuberculosis (15%) are among the most frequent causes of nonsurgical chylous ascites [4,5]. Case 1 had bile duct cancer, and it was presumed Typical chylous ascites is defined as TG > 200 mg/dl [1,3].…”

“…However, by circumventing the intestinal tract, it is possible to prevent TGs from leaking into the abdominal cavity from the broken lymphatic vessels. First, it is recommended that primary management of chylous ascites should involve the placement of a central venous catheter in a fasting patient to provide TPN while bypassing the intestinal tract [2,4,6].…”

“…Most cases of chylous ascites occur a er surgery [1][2][3], and the proportion of nonsurgical cases is low. e most frequent causes of nonsurgical chylous ascites include malignancies (25%), liver cirrhosis (16%), and tuberculosis (15%) [4,5]. Chylous ascites may be treated by ligation of broken lymphatic vessels a er surgery.…”

“…Chylous ascites may be treated by ligation of broken lymphatic vessels a er surgery. It is generally recommended to place a central venous catheter in a fasting patient as a means of delivering total parenteral nutrition (TPN) and bypassing the intestinal tract [2,4,6]. However, parenteral nutrition together with an oral fat-free elemental diet have reportedly been used as initial treatments for chylous ascites [7,8].…”

A Case of Idiopathic Chylous Ascites Simulating Rupture of Hemorrhagic Cyst in the Ovary

“…

Chylous ascites is a chronic process that very rarely presents as acute abdomen [1]. We report a case of a woman age 28 years who presented with acute abdomen and symptoms mimicking those of ruptured hemorrhagic cyst.

…”