Total Parenteral Nutrition in the Management of Traumatic Chylous Ascites in Infancy

Abstract

Chylous ascites is rare in the pediatric age group and usually of unknown etiology or due to congenital abnormalities of the lymphatic system. This report describes an infant with posttraumatic chylous ascites, unable to tolerate dietary therapy, in whom total parenteral nutrition allowed successful management. The experience gained in this case clarifies the management of chylous ascites from all causes. Specific recommendations for a treatment protocol are made.

Therapeutic management of neonatal chylous ascites: report of a case and review of the literature

“…The treatment of the underlying cause of chylous ascites is of pivotal importance in managing patients with chylous ascites. Chylous ascites may be the result of the intra-abdominal 'leaky-lymphatics' (5), congenital atresia and maldevelopment of the lymphatic vessels (6,7), intestinal malrotation (8,9), obstructive lesions (10,11), trauma (12,13), nonspecific bacterial, parasitic and tuberculous peritoneal infection (14), liver cirrhosis (15), malignancy (16) and surgical injury (14,15,17,18). In contrast, abdominal malignancy is the major cause in adults, while in children, congenital lymphatic abnormalities are more common (19).…”

Chylous Peritonitis in Children

“…We found eight cases (12%) that were secondary to either blunt abdominal injury or surgical procedures. The battered child syndrome should also be considered in any child with traumatic chylous peritonitis (6,8). The base of the mesentery is the usual site of traumatic chylous leakage.…”