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Case Reports
. 2012 Apr;16(2):175-80.

Diagnosis and management of congenital neonatal chylous ascites

V Mouravas  1 , O Dede, H Hatziioannidis, I Spyridakis, A Filippopoulos
Affiliations
Case Reports

Diagnosis and management of congenital neonatal chylous ascites

V Mouravas et al. Hippokratia. 2012 Apr.

Abstract

Background: Congenital chylous ascites is a rare condition that constitutes a challenge for the physician. It is defined as the accumulation of chyle into the peritoneal cavity in infants younger than 3 months. This condition is often refractory to therapy and it is responsible for serious malnutrition and immunological deficiency because of the loss of proteins and lymphocytes.

Material and methods: Four cases of congenital neonatal chylous ascites, were treated by our staff during the last two years. One case was treated conservatively and three with laparotomy. Two of them had intraabdominal cysts that were excised and one was treated with ligation of the left lumbar lymphatic trunk and cisterna chyli and the use of fibrin glue.

Results: All four cases were treated successfully. On follow up tests no one showed recurrence of the ascites. All children, except the one that treated conservatively and also had other problems due to prematurity, are growing up normally.

Conclusions: Congenital chylous ascites is a complex condition. Its diagnostic evaluation is difficult and its therapy of long duration. Conservative treatment is in most cases the initial choice, but when it fails, exploratory laparotomy could provide a successful alternative.

Keywords: chyloperitoneum; chylous ascites; cysterna chyli; intestinal duplication; mesenteric cyst; neonate.

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Figures

Figure 1
Figure 1. Thoracic CT, showing thickening of the interstitial space, a sign of possible pulmonary lymphangiectasia.
Figure 2
Figure 2. A: Milky fluid filling the peritoneal cavity. B: Mesenteric cyst with chyle. C: Thickened mesentery with dilated lymphatics.
Figure 3
Figure 3. A: Laparoscopic image of milky fluid in the peritoneal cavity. B: Dilated lymphatics and enlarged lymph nodes of the mesentery. C: A cyst bonded to the enteric wall.
Figure 4
Figure 4. A: Straw-coloured fluid from the peritoneal cavity through the drainage tube. B: Continuous suturing of the dilated left lymphatic lumbar trunk. C: Sutures on the cysterna chyli, scattered with fibrin glue. D: The patient 12 months after the operation.
See this image and copyright information in PMC

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