Chylous ascites associated with intestinal obstruction from volvulus due to Petersen's hernia: report of a case

Abstract

Background: Chylous ascites is an uncommon finding which is usually associated with recent abdominal/oncologic or retroperitoneal surgery. It is not usually seen in cases of acute obstruction.

Case presentation: A patient who had previously undergone a laparoscopy-assisted distal gastrectomy with Roux-en-Y reconstruction for early gastric cancer presented with acute abdominal pain and epigastric fullness. Computed tomography suggested small bowel obstruction due to volvulus. We were able to reduce the volvulus and close a Petersen's hernia without resecting the bowel; a large amount of chylous ascites was an incidental finding.

Conclusions: We present a case of chylous ascites occurring in a setting of small bowel obstruction due to Petersen's hernia, 3 years after successful distal gastrectomy for early gastric cancer, with no evidence of tumor recurrence.

Keywords: Chylous ascites; Intestinal obstruction; Ischemia.

Fig. 1

CT scan showing a large amount of ascites (red arrow) and whorl-like appearance of the superior mesenteric artery (SMA) and branches with adjacent collapsed loops of small bowel (yellow arrow)

Fig. 2

Milky fluid in the peritoneal cavity

Fig. 3

The small bowel passes through the defect between the jejunal mesentery (blue arrow) and the mesocolon. The jejunum was rotated 180° counterclockwise in the direction of the long axis (green arrows)

Fig. 4

CT performed 10 months after surgery shows no evidence of the recurrence of ascites

Fig. 5

CT performed 28 months after surgery shows increasing subcutaneous fat, indicating improvement in the patient’s health