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Chylous Ascites


Presentation

  • "Chylous ascites is a rare presentation of peritoneal effusion. The signet ring cell gastric adenocarcinoma is also relatively rare presentation of gastric cancer.[ncbi.nlm.nih.gov]
  • Acute peritonitis may be a presentation of primary intestinal lymphangiectasia and chylous ascites.[ncbi.nlm.nih.gov]
  • This case also signifies that chylous ascites may be a rare presenting feature of nephrotic syndrome and hence this aspect should be considered while in diagnostic dilemma regarding such a clinical presentation.[ncbi.nlm.nih.gov]
  • We describe a case of bladder cancer presenting with atraumatic chylous ascites, which remains an extremely rare presentation of this condition.[ncbi.nlm.nih.gov]
  • Congenital neuroblastoma may present with chylous ascites, probably due to disruption of the lymphatic vasculature.[ncbi.nlm.nih.gov]
Splenectomy
  • A 46-year-old man underwent living-donor liver transplantation and splenectomy for primary biliary cirrhosis. On postoperative day 22, cloudiness of ascites increased, and triglyceride concentration in ascites was as high as 1046 mg/dL.[ncbi.nlm.nih.gov]
Chest Discomfort
  • A 60-year-old man presented with exertional dyspnea, fatigue, and chest discomfort of 18-month history. Physical examination revealed S4, bilateral pretibial edema, and moderate amount of ascites.[ncbi.nlm.nih.gov]
Abdominal Distension
  • Among the reported cases of chylous ascites in pediatric patients, some patients experiencing abuse were identified on the basis of their chief complaints of vomiting or abdominal distension.[ncbi.nlm.nih.gov]
  • A patient developed abdominal distension, dyspnea, and nausea due to chylothorax and chylous ascites 1 month after bruising her back. Lymphangiography was unable to identify the site of lymph leakage, and lymphatic duct embolization was impractical.[ncbi.nlm.nih.gov]
  • We report the case of a newborn with CCA treated by fasting, TPN and octreotide for a period of 15 days until the abdominal distension was successfully reduced at which point treatment was switched to an MCT formula.[ncbi.nlm.nih.gov]
  • The authors present a case of a 51-year-old woman with clinical diagnosis of mixed connective tissue disease and overlap systemic lupus erythematosus features, with a 6-month history of progressive painless abdominal distension.[ncbi.nlm.nih.gov]
  • Treatment is typically conservative with the aim to alleviate abdominal distension and reduce the flow of lymph into the mesenteric lymph nodes. Postsurgical chylous ascites has high cure rate with conservative therapy alone.[ncbi.nlm.nih.gov]
Recurrent Abdominal Pain
  • Post LRGYB patients with symptoms of recurrent abdominal pain should be suspected for chylous ascites reflecting an internal hernia.[ncbi.nlm.nih.gov]
Akinesia
  • Transthoracic echocardiographic examination showed bilateral atrial enlargement, left ventricular hypertrophy, anteroseptal hypokinesia and akinesia, and moderate mitral and tricuspid regurgitation, with an ejection fraction of 25%.[ncbi.nlm.nih.gov]

Workup

Penicillium
  • Penicillium marneffei (P. marneffei) infection usually occurs with skin, bone marrow, lung or hepatic involvement. However, no cases of P. marneffei infection with chylous ascites have been reported thus far.[ncbi.nlm.nih.gov]

Treatment

  • However, treatment options should be personalized, and the right treatment should be chosen for each patient. The best measure is to pay utmost attention to the ligation of large lymph vessels during lymph dissection.[ncbi.nlm.nih.gov]
  • Few cases have been described and no gold standard treatment has been defined so far.[ncbi.nlm.nih.gov]
  • The treatment option for this condition is primarily conservative. Surgery is considered after failure of conservative treatment and its role, however, remains controversial.[ncbi.nlm.nih.gov]
  • Conservative treatment has been shown to be effective in almost all cases and is the treatment of choice. Copyright 2016 Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
  • Antimycobacterial regimen improved his symptoms; however, following an interruption in treatment, he developed chylous ascites. The patient died of uncontrolled peritonitis despite intensive treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Postoperative chyloperitoneum has a benign course and an excellent prognosis.[ncbi.nlm.nih.gov]
  • SVCA, which was successfully treated with conservative management, was associated with a prolonged hospital stay but was not associated with the prognosis.[ncbi.nlm.nih.gov]
  • Chylous ascites is a rare form of ascites, the presence of which generally denotes a very poor long term prognosis.[mayoclinic.pure.elsevier.com]
  • The incidences of CA and prognosis in the EEN and later EN groups were examined with nutrition preparation of polymeric formula or semielemental feed. RESULTS: Thirteen (15.29%) of 85 patients were identified with CA.[ncbi.nlm.nih.gov]
  • The dismal prognosis in adult cases (12 patients died within 3 months) shows the need for appropriate diagnostic assessment including early lymph node biopsy or laparotomy, or both, when indicated.[annals.org]

Etiology

  • This case illustrates the difficulty in establishing etiology in some patients and the effectiveness of total parenteral nutrition plus octreotide therapy in idiopathic chylous ascites in HIV-infected patients.[ncbi.nlm.nih.gov]
  • An internal hernia limb defect is thought to be the underlying etiology, where the hernia will cause lymphatic vessel engorgement and lymphatic extravasation.[ncbi.nlm.nih.gov]
  • The prompt diagnosis is important for optimize the etiology evaluation and therapeutically approach."[ncbi.nlm.nih.gov]
  • All laboratory analyses for possible etiologies including neoplasms, tuberculosis, and cirrhosis were negative. Positron-emission tomography did not show any pathological uptake.[ncbi.nlm.nih.gov]
  • Treatment with nutritional optimization and management of the underlying etiology are the cornerstones of therapy.[ncbi.nlm.nih.gov]

Epidemiology

  • STUDY OBJECTIVE: To evaluate the clinical presentation, epidemiology, risk factors, and treatment of chylous ascites after laparoscopic lymphadenectomy to treat gynecologic malignancies.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiologic mechanism of cirrhosis-related chylous fluid collections is believed to be excessive lymph flow resulting from portal hypertension.[ncbi.nlm.nih.gov]
  • Traditional methods involving ligation of lymphatic fistulas or small bowel resection do not address the basic pathophysiologic mechanism of the underlying obstruction, and identification of chyloperitoneal fistulas may be challenging.[ncbi.nlm.nih.gov]
  • METHODS: A literature search was conducted using PubMed using the key words 'chylous', 'ascites', 'cirrhosis', 'pathophysiology', 'nutritional therapy', 'paracentesis", "transjugular intrahepatic portosystemic shunt" and "TIPSS'.[ncbi.nlm.nih.gov]
  • The pathophysiology has not been clearly defined, the underlying disease often proves elusive with present diagnostic procedures, and effective therapy is frequently not possible.[jamanetwork.com]
  • CCA is a rare condition, and there is limited understanding of its pathophysiology and treatment options.[acgcasereports.gi.org]

Prevention

  • Despite use of diuretics and sirolimus to reduce ascites-associated symptoms and to prevent gastroesophageal reflex triggered by increased abdominal pressure, the ascites were refractory, and periodic paracenteses were required.[ncbi.nlm.nih.gov]
  • To manage this complication, we propose preventive and treatment strategies based on symptoms and amount of chylous ascites using our experience and review of the literature. Copyright 2015 Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Using BLOODCARE powder during retroperitoneal surgery may prevent PCA. This simple, effective agent should be used after PPALN for gynecological cancers.[ncbi.nlm.nih.gov]
  • Anti-infective therapy can prevent intra-abdominal infections and the occurrence of bacteremia. Considering postoperative treatments last longer in this case, the authors changed antibiotics several times to avoid drug resistance.[ncbi.nlm.nih.gov]
  • However, to prevent recurrence, the patient consumed a low-fat medium chain triglyceride diet for 6 months.[ncbi.nlm.nih.gov]

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