Chylous ascites (CA) is a rare condition characterized by the accumulation of milky-appearing, triglyceride-rich peritoneal fluid that originates from the leakage of lymph from the thoracic or intestinal lymphatic system .
CA can be classified into congenital or acquired, depending on the underlying cause of lymphatic disruption. Congenital CA is usually due to lymphatic malformations or anomalies, while acquired CA is usually due to trauma, surgery, malignancy, infection, inflammation, or cirrhosis .
The diagnosis of CA is based on the clinical presentation, laboratory analysis, and imaging studies of the peritoneal fluid. The typical features of CA are:
- A milky or opalescent appearance of the fluid
- A high triglyceride level (>200 mg/dL) and a low cholesterol level (<200 mg/dL)
- A high protein level (>2.5 g/dL) and a high lymphocyte count (>80%)
- A positive Sudan III stain for fat globules
- A negative culture for bacteria or fungi
The differential diagnosis of CA includes other causes of turbid or bloody ascites, such as pancreatic ascites, bacterial peritonitis, tuberculous peritonitis, hemorrhagic ascites, or pseudochylous ascites .
The treatment of CA depends on the underlying cause and the severity of symptoms. The general principles of treatment are:
- Medical therapy: Octreotide, a somatostatin analog, can reduce the splanchnic blood flow and the secretion of chyle. Other drugs that have been used include diuretics, anti-inflammatory agents, antibiotics, anticoagulants, and fibrinolytics
- Interventional therapy: Paracentesis can relieve the symptoms of abdominal distension and discomfort. Total parenteral nutrition (TPN) can provide adequate nutrition and rest the bowel. Peritoneovenous shunt (PVS) can divert the chylous fluid from the peritoneal cavity to the systemic circulation. Lymphangiography can identify the site of lymphatic leakage and deliver sclerosing agents to seal it
- Surgical therapy: Surgery is indicated when medical or interventional therapy fails or when there is a correctable cause of lymphatic obstruction or injury. Surgical options include ligation, resection, anastomosis, or bypass of the affected lymphatic vessels or organs
There is no specific evidence for chyloascites and critically ill patients. For more information on critically ill patients, refer to the ascites info sheet.
References