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

Abstract

Background: Primary volvulus of the small intestine associated with chylous ascites is very rare, with only four reported cases. In this paper, we report a new case of primary volvulus associated with chylous ascites.Case Presentation: The patient was a 70-year-old man. After experiencing bloating and abdominal pain for several hours, he called an ambulance and underwent an emergency examination at our hospital.Abdominal distension, pressure pain, and rebound tenderness were observed throughout his entire abdomen. The patient had a history of hypertension for which he was receiving oral treatment. Abdominal contrast-enhanced computed tomography (CT) revealed an edematous change in the intestinal membrane and volvulus of the small intestine. As findings suggestive of ischemia were observed in part of the intestines, emergency surgery was performed on the day of admission. Open surgery revealed approximately 500 mL of chylous ascites in the abdominal cavity. The small intestine had twisted 180°in a counter-clockwise direction at the root of the superior mesenteric artery, and the mesentery appeared milky white with edematous changes extending 75 to 240 cm from the ligament of Treitz.There was no evidence of intestinal necrosis; therefore intestinal resection was not performed. The volvulus of the small intestine was corrected. Moreover, because there was no other underlying disease observed, surgery was completed. The ascites collected during surgery revealed high levels of triglycerides at 332 mg/dL, and chylous ascites was diagnosed. An abdominal CT performed on the third day after surgery showed an improvement in intestinal edema, and primary volvulus of the small intestine associated with chylous ascites was diagnosed. Postoperative progress was good, and the patient was discharged on hospital day 10. (J Nippon Med Sch 2017; 84: 83 86)

Acute Chyloperitoneum with Small Bowel Volvulus: Case Series and Systematic Review of the Literature

“…Given that lymph is produced from venous blood, lymph leakage can occur due to the maintenance of arterial blood flow. Therefore, the presence of chylous ascites could suggest a high probability of intestinal preservation, thanks to the conservation of blood flow [11]. Indeed, in all analyzed cases, including our two cases, no intestinal necrosis was observed, and bowel resection was not necessary.…”

“…Chyloperitoneum has multifarious etiologies [2,[4][5][6], with abdominal malignancy and cirrhosis being predominant in Western countries, while infectious causes like tuberculosis and filariasis are prevalent in Eastern and developing regions [2]. An uncommon yet noteworthy cause is small bowel volvulus [11][12][13][14][15][16][17][18][19][20][21].…”

Rare Combination of Chyloperitoneum Secondary to Primary Small-Bowel Volvulus

“…The literature for mesenteric lymphatic infiltration and small bowel volvulus is scarce and focuses primarily on paediatric cases or patients with a surgery or intra-abdominal radiotherapy past [5][6][7][8][9]. Only a few case reports and small case series [10][11][12] describe this unique combination.…”

“…Athanasiadis et al [9] proposed that the presence of chylous ascites with intestinal strangulation due to internal hernia is an innocuous finding. Hayama et al [12] theorize that chylous ascites in a patient with volvulus or internal hernia is innocuous and it may reflect the patency of the mesenteric vessels. In our case…”

Massive Chylous Ascites in a 9-Year-Old Girl with Malrotation—A Case Report

“…Intestinal malrotation as the cause of massive chylous ascites is uncommon in school-age children. 1 2 3 4 Intestinal malrotation is predominately diagnosed in earlier years of life due to the obstructive effect the Ladd's band have on the intestines, blood vessels, and lymphatic system. 5 The majority is found within the first month (30%) or year (55–60%) in life, and 75% is diagnosed before 5 years of age.…”