Chylous ascites as a marker for intestinal viability in a small bowel obstruction: a case report

Abstract

Chylous ascites (CA) is the uncommon extravasation of triglyceride-rich fluid into the abdominal cavity as a result of the disruption of the abdominal lymphatic system. A patient who had previously undergone a subtotal colectomy presented with a closed-loop small bowel obstruction (SBO), underwent an emergency laparotomy with adhesiolysis and had intra-operative findings of milky intra-abdominal free fluid confirmed on analysis as CA. His post-operative period was complicated by a prolonged ileus, and following resolution, he was subsequently discharged home. Here, we present a case of a closed-loop SBO in which CA may be an indicator of intestinal viability.

Figure 1

Dilated loops of small bowel (blue arrow), oedematous mesentery (suggestive of closed-loop obstruction; red arrow), free fluid (evidence of CA; white arrow) and collapsed small bowel (orange arrow)

Figure 2

Dilated loops of small bowel (blue arrow), transition point (red arrow), free fluid (evidence of CA; white arrow) and collapsed small bowel (orange arrow).