Intestinal torsion causing chylous ascites: a rare occurrence

Abstract

C a s e R e p o r t e88 INTRODUCTIONSince the first case of acute chylous peritonitis described by Renner (1) CASE REPORTA Computed tomography (CT) showed a whirl-like appearance, with a collapsed bowel around the superior mesenteric artery (Fig. 1). There was also an abrupt cut-off of the superior mesenteric vein just distal to the splenoportal confluence (Fig. 2). This was suggestive of intestinal torsion.On exploratory laparotomy, two litres of chylous fluid was drained from the peritoneal cavity. The small bowel mesentery was torted around an adhesion band between the transverse colon and duodenum. The small bowel mesentery was found to be long and narrow, and the position of the caecum was to the right and more cranial than usual. The bowel was well-perfused, pink and only mildly dilated. Superior mesenteric arterial pulsations were prominent.The bowel was detorted in a counterclockwise manner and the coloduodenal adhesion band was taken down. AdhesionsIntestinal torsion causing chylous ascites: a rare occurrence ABSTRACT Intestinal torsion and chylous ascites are very rarely associated. We present the case of a 19-year-old man who presented with acute abdomen. Computed tomography of his abdomen showed features suggestive of intestinal torsion. Chylous ascites was incidentally discovered on exploratory laparotomy. The chylous fluid was drained, the small bowel detorted and the coloduodenal adhesion band taken down. The patient's retroperitoneum was explored to exclude occult masses and malformations of the lymphatics. Post surgery, the patient recovered uneventfully. In this case, we postulate that intestinal malrotation had caused the obstruction of the lymphatic flow from the mesenteric lymphatic channels, leading to the exudation of chyle, which then resulted in the accumulation of chylous fluid in the peritoneal cavity. It is important to exclude the more common causes of atraumatic chylous ascites, such as enlarged retroperitoneal lymph nodes or lymphatic malformations.

Chylous ascites associated with intestinal obstruction from volvulus due to Petersen’s hernia: report of a case

“…Detecting a cause of chylous ascites associated with bowel obstruction is difficult, because these cases are so rare. Of note, however, no previous studies [ 15 – 22 ] reported the requirement for an enterectomy, and their postoperative courses were uneventful.…”

Case report of chylous ascites with strangulated ileus and review of the literature

“…Eight of the 22 cases did not have history of surgery, and seven of those eight cases had volvulus, or torsion of the small intestine [24][25][26][27][28][29][30], while our case had incarcerated internal hernia of the small intestine by band formation after radiation therapy for cervical cancer of the uterus (Table 3).…”

Primary Volvulus of the Small Intestine Exhibiting Chylous Ascites: A Case Report

“…There have been 12 reported cases of chylous ascites, including that by Koh et al 10 and Japanese reports of strangulated ileus with chylous ascites 11 , all of which involved strangulation that did not require intestinal resection.…”