Chylous ascites after living related liver transplantation treated with somatostatin analog and parenteral nutrition

Abstract

Chylous ascites are the accumulation of chylomicron-rich lymphatic fluid within the peritoneal cavity, resulting from obstruction or disruption of abdominal lymphatic channels. This rare condition may be associated with neoplastic or infectious infiltration of lymphatics, with pancreatitis, and with abdominal surgery. It may occur spontaneously in 0.5% of patients with cirrhosis; but only among a few liver transplantation cases. The management of chylous ascites is controversial; the variety of described treatments include repeated paracentesis, dietary control, peritoneovenous shunting, and surgical ligation of the disrupted lymphatic channels. In this article, we report 2 cases of rapid resolution of chylous ascites after liver transplantation following 5 days of treatment using a somatostatin analog and total parenteral nutrition (TPN). A 3.5-year-old girl and a 5-year-old girl underwent living related liver transplantation for biliary atresia and hepatoblastoma, respectively. Chylous ascites, diagnosed by ascitic fluid examination, developed within the 2 weeks after transplantation in the 2 cases. Treatment by fasting, TPN, and somatostatin analog resulted in rapid resolution of the ascites within 1 week. The prevalence of chylous ascites was noted in 1.6% of children (2/119) after liver transplantation. These cases highlight the use of somatostatin analog and parenteral nutrition in chylous ascites after liver transplantation.