Intractable congenital chylous ascites

Abstract

A male newborn presented with congenital chylous ascites, the treatment of which is difficult and complicated due to persistent loss of chyle. The primary therapeutic goal is to reduce the lymph flow and to allow the leakage to heal naturally. Usually, conservative management—enteric rest with total parental feeding or an enteral diet with medium‐chain triglycerides—can achieve this. A new treatment option is the use of octeotride, a somatostatin analogue. Both therapies failed in our patient, and surgical ligation of the leaking lymphatic duct was successful. Conclusion: The success of the surgical treatment depends on localizing the leaking lymphatic duct. Lymphatic imaging with lymphoscintigraphy and pre‐operative administration of lipophilic dye can assist the surgeon.

A case of congenital chylous ascites and hypothyroidism: coincidence or association?

“…[3,7] Although some investigators have reported the successful use of octreotide in congenital CA, [4,8] others have demonstrated octreotide to be inadequate even at a maximum intravenous (IV) dose of 10 μg/kg/h. [9] A study conducted by Huang et al [4] used octreotide at 1.5 μg/ kg/h IV for 10 days, whereas other studies used octreotide at an initial dose of 0.5 μg/kg/h IV, gradually titrated to 2 μg/ kg/h for nine days. [8] In our case, octreotide was started at 3 μg/kg/h and increased to 8 μg/kg/h following unresponsiveness to lower doses.…”

A newborn with chylous ascites caused by intestinal malrotation associated with heterotaxia syndrome

“…Infant formulas containing a higher proportion of medium chain triglycerides (which are directly absorbed into the portal system bypassing the lymphatics) or enteric rest with total parenteral nutrition support are the initial measures utilized. One to 2 months of conservative therapy has been suggested [4]. The response to conservative therapy has been variable [2] and controversy exists regarding the duration of this treatment modality before considering surgical intervention.…”