Management of chylous ascites after liver cirrhosis: A case report

Abstract

Background: Chylous ascites is an uncommon condition, occurring in less than 1% of ascites cases. It results from traumatic or obstructive disruption of the lymphatic system, causing the leakage of thoracic or intestinal lymph into the abdominal cavity. This leads to the accumulation of a milky, triglyceride-rich fluid. In adults, malignancy and cirrhosis are the primary causes of chylous ascites. Notably, chylous ascites accounts for only 0.5% to 1% of all cirrhosis-related ascites cases. At present, there is a limited understanding of this condition, and effective timely management in clinical practice remains challenging.

Case summary: This case report presents a patient with hepatic cirrhosis complicated by chylous ascites, who had experienced multiple hospitalizations due to abdominal distension. Upon admission, comprehensive examinations and assessments were conducted. The treatment strategy focused on nutritional optimization through a low-sodium, low-fat, and high-protein diet supplemented with medium-chain triglycerides, therapeutic paracentesis, and diuretics. Following a multidisciplinary discussion and thorough evaluation of the patient's condition, surgical indications were confirmed. After informing the patient about the benefits and risks, and obtaining consent, a transjugular intrahepatic portosystemic shunt procedure was performed, successfully alleviating the abdominal swelling symptoms. This article details the clinical characteristics and treatment approach for this uncommon case, summarizing current management methods for hepatic cirrhosis complicated by chylous ascites. The aim is to provide valuable insights for clinicians encountering similar situations.

Conclusion: Optimizing nutrition and addressing the underlying cause are essential in the treatment of chylous ascites. When conservative approaches prove ineffective, alternative interventions such as transjugular intrahepatic portosystemic shunt may be considered.

Keywords: Case report; Chylous ascites; Liver cirrhosis; Management; Transjugular intrahepatic portosystemic shunt.

Figure 1

Abdominal computed tomography.

Figure 2

Additional assessments to evaluate the patient’s condition. A Chest X-ray; B: Electrocardiogram; C: Gastroscopy.

Figure 3

Chylous ascites.

Figure 4

Transjugular intrahepatic portosystemic shunt.