We report the first case of chylous ascites following radical nephrectomy for a renal cell carcinoma involving the right half of a crossed fused renal ectopia. Chylous ascites refers to the accumulation of lipidrich lymph in the peritoneal cavity due to disruption of the lymphatic system. Chylous ascites is a rare complication in patients undergoing peritoneal dialysis. Chylous ascites is a wellknown clinical entity associated with lymphatic obstruction usually caused by neoplasms, inflammation, and congenital anomalies. The word ascites is derived from the greek word askos meaning bag or bladder. Chylous ascites is a rare form of ascites resulting from an accumulation of lymph in the abdominal cavity. Treatment with methimazole was effective in reducing her tremor and tachycardia. Its true incidence has never been well established,5 although it can be estimated at about one in 20,000 admissions to a large universitybased 6hospital. There are only a few reported cases of chylous ascites.
It is due to an interruption in the lymphatic system. For a chyle leak that is refractory to surgical repair, no good options exist. Postoperative chylous ascites ca, defined as the accumulation of lipid. Chylous ascites ca is an uncommon clinical condition and occurs as a result of. Chylous ascites is a milkyappearing peritoneal fluid that is rich in triglycerides. Publications dealing with chylous ascites following surgery, radiotherapy, and trauma were excluded. The management is very specific to the etiology and clinical status of the patient. Pdf chylous ascites refers to the accumulation of lipidrich lymph in the peritoneal cavity due to disruption of the lymphatic system secondary to.
Data on postoperative chylous ascites ca after pediatric liver transplantation lt are scarce. Damage or obstruction to the lymphatic system or one of its tributaries produces ascites with a turbid or milky appearance from the high triglyceride content. We report a patient who developed chylous ascites after an otherwiseuneventful laparoscopic donor nephrectomy. Chylous pleural effusions are usually due to thoracic duct transection by trauma. This retrospective study was conducted to identify the incidence, risk factors, management, and outcomes of postoperative ca in a large single.
Menu hyperlinks allow movement between sections and to the guidelines on the aasld site. Chylous ascites frequently presents as progressive and painless abdominal distention. Chylous ascites after laparoscopic donor nephrectomy. Options for nutrition complications of his condition management include. Disease bioinformatics research of chylous ascites has been linked to chylous ascites, malignant neoplasms, neoplasms, liver cirrhosis, pleural effusion disorder. Chylous ascites, disseminated tuberculosis, ascites in tuberculosis. It is due to the presence of thoracic or intestinal lymph in the abdominal it seems to us that you have your javascript disabled on your browser. She showed acute abdominal pain and significant systemic inflammatory response, but her serum amylase and lipase. Graves disease with intractable diarrhea, chylous ascites. Patients with chylous ascites present in a similar manner to those with other types of ascites, namely abdominal distention with a fluid wave or shifting dullness, abdominal pain, anorexia, dyspnea, inguinal hernias, and scrotal or labial edema. Chylous ascites ca is an uncommon form of ascites, defined as the leakage of the lipidrich lymph into the peritoneal cavity.
Chylous ascites is a rare form of ascites characterized by milklike peritoneal fluid, rich in triglycerides. Pdf chylous ascites ca is a rare form of ascites that results from the leakage of lipidrich lymph into the peritoneal cavity. Multiple causes have been described, with the most common causes being malignancy hepatoma, small bowel lymphoma, small bowel angiosarcoma, and retroperitoneal lymphoma, cirrhosis. A variety of causes have been well defined, including liver cirrhosis, malignancies, infectious diseases, traumatic causes, postoperative conditions. The diagnosis is established when the concentration of triglycerides in the ascitic fluid is 200 mgdl 1. It is important to be aware of this condition as it may be confused with peritonitis. Diagnosis, outcome, and management of chylous ascites. Causes of chylous ascites include obstruction of lymphatic drainage by cirrhosis or portal vein thrombosis, and rare cases of congenital lymphatic anomalies may be the cause in children. Unfortunately, these benefits are sometimes negated by postoperative complications. In developing countries, the commonest etiology is infection with tuberculosis and filariasis.
Chylous ascites is an uncommon finding in children, arising from obstruction of lymphatic drainage or secondary to trauma. Clinical utility of planar scintigraphy and tomographic imaging with spectct article pdf available in nuklearmedizin 545 july 2015 with 1,100 reads. Asellius, in 1622, first described the lymphatic system in a dog after observing vessels. Two common forms are caused by liver cirrhosis liver disease, or certain cancers of the abdomen. Lowdose radiation therapy is an effective treatment for.
It is a rare condition that can be caused by many different factors. The mortality from chylous ascites is not negligible, and aggressive measures are often needed. Chylous ascites is an uncommon clinical condition that occurs as a result of disruption of the abdominal lymphatics. Most often, the diagnosis of chylous ascites is not considered before performing a paracentesis. The study of chylous ascites has been mentioned in research publications which. Ascites results either due to blockage of the lymphatics or leak secondary to inadvertent trauma during surgery. Octreotide therapy for the management of refractory. In gynecology, the most common cause for its occurrence is lymph dissection leading to impairment of major lymphatic vessels. Diagnosis and management of primary chylous ascites.
Chylous ascites as a consequence of idiopathic pancreatitis. A case of chylous ascites with pulmonary tuberculosis and caries of the spine is reported, perhaps the first such case recorded in india. Primary chylous ascites can be congenital or may appear later in life, depending on the patients genetic complexity and on the environmental effects. Chylous ascites is a condition characterized by accumulation of triglyceriderich fluid in the peritoneum and results from various etiologies that cause disruption of the lymphatic system. Chylous ascites ca is a rare form of ascites that results from the leakage of lipidrich lymph into the peritoneal cavity. Evaluation of ascites ascites is defined as an abnormal accumulation of fluid in the abdominal cavity. Chylous ascites is the accumulation of milky chyle in the peritoneal cavity. The patient we describe was a 51yearold woman with medical history of radiotherapy for cervical cancer of the uterus 15 months prior to being admitted to our hospital with abdominal pain. Our literature search did not reveal any reports of chylous ascites after a gastric ulcer resection. Chylous ascites genetic and rare diseases information.
A study including patients with nephritic syndrome and ascites, showed that % of those who underwent paracentesis had ca. Primary chylous ascites is closely correlated to lymphaticlymphonodal dysplasia that does not. Chylous ascites refers to the accumulation of lipidrich lymph in the peritoneal cavity due to disruption of the lymphatic system secondary to traumatic injury or obstruction. A patient is reported with chylous ascites associated with cirrhosis and portal hypertension in whom the ascites, the renal insufficiency and the fluid and electrolyte disturbances were corrected by the insertion of a denver peritoneovenous shunt. Chylous ascites associated with atrioventricular valve. Chylous ascites ca is a rare form of ascites that results from the leakage of lipid rich lymph into the peritoneal cavity. Medicina free fulltext first case of chylous ascites. After developing ascites that necessitates hospitalization, the risk of mortality. Chylous ascites as a complication of laparoscopic donor. Diagnosis and management of primary chylous ascites sciencedirect. Acute and chronic pancreatitis are known causes of chylous ascites. This condition has the potential to cause significant morbidity in the donor, which may reduce the advantages of the minimally invasive approach. However, normal serum lipase and amylase activity in htgap with chylous ascites is exceptionally rare. In addition, patients with chylous ascites may exhibit diarrhea caused by malabsorption, which results in malnutrition or anemia.
Percutaneous treatment of chylous ascites sciencedirect. Worldwide, abdominal malignancy, cirrhosis, and tuberculosis are the commonest causes of ca in adults, the latter being most prevalent in developing countries, whereas congenital abnormalities of the lymphatic system and. Management of adult patients with ascites due to cirrhosis. Atraumatic chylous ascites american college of surgeons. We report a pregnant woman with htgap and chylous ascites that were misdiagnosed. It may occur due to traumatic peritoneal dialysis catheter insertion or other causes. Chylous ascites refers to the accumulation of lipidrich lymph in the peritoneal cavity due to disruption of the lymphatic system secondary to. Chylous ascites is a type of ascites, the cause of which includes different factors, such as blunt trauma to the abdomen, cancer, liver cirrhosis and some surgical procedures.
Chylous ascites is characterized by lymphatic fluid leaking into the abdominal cavity and has a prevalence of 120,000 hospital admissions 1. Chylous ascytes secondary to acute pancreatitis nutricion. Chylous ascites is rare if found in the pediatric age group, and is usually of unknown etiology or comes from congenital anomalies of the lymphatic system. A 50yearold woman was admitted to our hospital because of severe diarrhea, irritableness, and severe pitting edema of the legs. Case report of chylous ascites with strangulated ileus and. Chyle is a thick, milky substance, which consists of. Rarely, severe right heart failure from constrictive pericarditis, rheumatic valvulopathy, and dilated cardiomyopathy have been associated with chylous ascites because of high central venous pressure and alterations of lymphatic formation. Extracorporeal peritoneovenous shunt for the management of. Chylous ascites refers to a leakage of a natural bodily fluid called chyle into the abdominal cavity from a duct in the lymphatic system. Acute hyperlipidemic pancreatitis accompanied by chylous. When lymphatic pathways are disrupted via obstruction or traumatic injury, a temporary or chronic chyle leak may result, which is defined as the presence of chyle that collects outside of the lymphatic vessels within the thoracic or abdominal cavities. Reports focusing on the management of chylous ascites without in. Chylous ascites is a rare condition where there is leakage of chyle, which is a natural body fluid, into the abdominal cavity from a duct in the lymphatic system.
Chylous ascites may result from diverse pathologies. Diagnosis and management of primary chylous ascites journal of. The patient had been well until 5 years before admission, when a tremor and tachycardia developed and a diagnosis of graves disease was made. Among these, chylous ascites ca is a rare but serious problem that is usually managed conservatively. However, the diagnosis was based on detection of opalescent e usion rather than by checking the triglyceride level of peritoneal uid. Chylous ascites, emedicine specialties, e medicine, gastroenterology, liver. We report a case treated conservatively with total parenteral nutrition tpn and octreotide.
Chylous ascites is the accumulation of triglyceriderich, free, milklike peritoneal fluid caused by the. On medline search, we could find only two other cases with similar complications. Chylous ascites clinical kidney journal oxford academic. Malignancy malignancy is a common cause of chylous ascites in adults, and lymphoma accounts for at least one half to one third of the cases according to a. Chylous ascites definition of chylous ascites by medical. Chylous ascites is a rare disease, only two cases associated with gastroschisis have been published. Blunt trauma to the abdomen, cancer, liver cirrhosis, and surgical procedures can all lead to this condition. When the buildup of fluid contains chyle a milky fluid thats a combination of lymphatic fluid and fat, this form of ascites is known as chylous ascites and is a lymphatic flow disorder. Without treatment, a person can experience severe abdominal pain, nausea, and.
Compared with open donor nephrectomy odn, this alternative has many advantages including less postoperative pain and earlier return to work. It is due to the presence of thoracic or intestinal lymph in the abdominal cavity. Chylous ascites, defined by a triglyceride concentration of 110 mgdl 1. New onset ascites hospitalization of a patient with ascites clinical deterioration of an inpatient or outpatient with ascites fever abdominal pain abdominal tenderness hepatic encephalopathy peripheral leukocytosis deterioration in renal function 25 1252014 21. Its true incidence has never been well established, 5 although it can be estimated at about one in 20,000 admissions to a large universitybased hospital. Chylous ascites has been reported after surgeries like abdominal aortic aneurysm repair, radical gastrectomy, duodenectomy, nephrectomy and wilms tumor resection. Normal serum amylase is uncommon even in acute hypertriglyceridemic pancreatitis htgap.
Sudden outpouring of chyle into the peritoneal cavity may produce acute chylous peritonitis. Chylous ascites is a rare form of ascites caused by accumulation of lymph in the peritoneal cavity, usually due to intraabdominal malignancy, liver cirrhosis or abdominal surgery complications, and present with painless but progressive abdominal distension, dyspnea and weight gain. Clinical signs and symptoms include abdominal distention, pain, nausea, and vomiting. Chylous ascites is an uncommon complication after aortic and other retroperitoneal surgeries.
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