Chylous Ascites

Recent literature suggests that chyle leak may complicate up to 10% of pancreatic resections. Treatment depends on its severity, which may include chylous ascites. No international consensus definition or grading system of chyle leak currently is available. The International Study Group on Pancreatic Surgery, an international panel of pancreatic surgeons working in well-known, high-volume centers, reviewed the literature and worked together to establish a consensus on the definition and classification of chyle leak after pancreatic operation. Chyle leak was defined as output of milky-colored fluid from a drain, drain site, or wound on or after postoperative day 3, with a triglyceride content ≥110 mg/dL (≥1.2 mmol/L). Three different grades of severity were defined according to the management needed: grade A, no specific intervention other than oral dietary restrictions; grade B, prolongation of hospital stay, nasoenteral nutrition with dietary restriction, total parenteral nutrition...

Phosphoinositide 3-kinases produce 3'-phosphorylated phosphoinositides that act as second messengers to recruit other signalling proteins to the membrane. Pi3ks are activated by many extracellular stimuli and have been implicated in a variety of cellular responses. The Pi3k gene family is complex and the physiological roles of different classes and isoforms are not clear. The gene Pik3r1 encodes three proteins (p85 alpha, p55 alpha and p50 alpha) that serve as regulatory subunits of class IA Pi3ks (ref. 2). Mice lacking only the p85 alpha isoform are viable but display hypoglycaemia and increased insulin sensitivity correlating with upregulation of the p55 alpha and p50 alpha variants. Here we report that loss of all protein products of Pik3r1 results in perinatal lethality. We observed, among other abnormalities, extensive hepatocyte necrosis and chylous ascites. We also noted enlarged skeletal muscle fibres, brown fat necrosis and calcification of cardiac tissue. In liver and ...

SUMMARY:  Chylous ascites, a rare complication in patients receiving continuous peritoneal dialysis, often presents with turbid dialysate. This characteristic makes it frequently confused with peritonitis. Conservative treatments including bowel rest and dietary intervention with medium chain triglycerides are advised by many authors in the literature. However, this approach usually takes a long time before the lymphorrhagia are eventually resolved. Here, a case of chylous ascites that was successfully treated with subcutaneous octreotide, a somatostatin analogue, is reported. By shortening the bowel rest period, this treatment avoids the nutritional and immunological adverse effects. A series of peritoneal equilibrium tests were performed after administration of octreotide and the results showed that octreotide did not alter the peritoneal function in the short term. Therefore, subcutaneous octreotide administration is a safe and effective therapy in peritoneal dialysis patient with chylous ascites.

SUMMARY:  Chylous ascites, a rare complication in patients receiving continuous peritoneal dialysis, often presents with turbid dialysate. This characteristic makes it frequently confused with peritonitis. Conservative treatments including bowel rest and dietary intervention with medium chain triglycerides are advised by many authors in the literature. However, this approach usually takes a long time before the lymphorrhagia are eventually resolved. Here, a case of chylous ascites that was successfully treated with subcutaneous octreotide, a somatostatin analogue, is reported. By shortening the bowel rest period, this treatment avoids the nutritional and immunological adverse effects. A series of peritoneal equilibrium tests were performed after administration of octreotide and the results showed that octreotide did not alter the peritoneal function in the short term. Therefore, subcutaneous octreotide administration is a safe and effective therapy in peritoneal dialysis patient with chylous ascites.

Chyloperitoneum is a rare intra-abdominal finding in internal hernia, only a few cases reports mentioned in the literature. It presents around 0.001-0.005% of hospital admissions. The presence of chylous ascites and swirl sign in a patient is a good indication of internal hernia and the bowel's validity.

The authors report the first case of chylous ascites and chyluria in a 65-year-old Thai women with nephrotic syndrome due to focal segmental glomerulosclerosis (FSGS), tip variant. She presented with generalized edema and abdominal discomfort. Abdominal paracentesis revealed milky white fluid. Chylous ascites was confirmed. Abdominal and thoracic computed tomography did not show any cause of chylous ascites and chyluruia. Lymphoscintigraphy could not demonstrate lymph flow obstruction and connection between lymphatic pathway and KUB system. Those could have explained the chylous ascites or chyluria. Hypoalbuminemia-induced bowel edema may predispose to change the permeability of mucosal or serosal lymphatics. This could result in chylous ascites but the cause of chyluria could not be determined in this case.

Purpose Chylous ascites is an infrequent postoperative complication after retroperitoneal surgical procedure. Despite its infrequent occurrence, postoperative chylous ascites are associated with significant morbidity. Reports of chylous ascites or fistula after retroperitoneal lymph ...

Background: Congenital chylous ascites is a condition that arises from a disorder of the abdominal lymphatic system.
Case Report: In this case study, a nine-month-old infant diagnosed with congenital chylous ascites in the newborn period
presented with hypertension and chylous ascites.
Conclusion: His hypertension was disappeared with the effective treatment of ascites. Patients with chylous ascites should
be carefully evaluated concerning hypertension.

Chylous ascites (CA) is an uncommon form of ascites characterized by a milky white appearance of the dialysiate due to triglycerides and chylomicrons accumulation in the peritoneal dialysate. It can be a rare complication or finding in peritoneal dialysis (PD) patients. Although the milky-looking fluid may suggest peritonitis on a first inspection, the presence of triglycerides in the fluid and the absence of other symptoms are decisive. CA can be secondary to multiple processes, highlighting neoplasms, traumatic causes, and some infections such as tuberculosis. It should be noted that some secondary to treatment with calcium blockers have been described in patients on PD. However, in some cases it is not associated with any etiology, and it is deemed as idiopathic.

Background Chyloperitoneum is the accumulation of lymphatic fluid in the peritoneal cavity. Although uncommon, it has been reported after retroperitoneal lymph node dissection. But the incidence of this complication after radical gastrectomy is unknown. In the present study, we analyzed our patients who underwent D3 dissection for gastric carcinoma and developed chyloperitoneum. Methods Between June 1999 and June 2002, a total of 134 patients with gastric cancer underwent radical lymph node dissection, performed according to the Japanese Research Society for Gastric Cancer guidelines, as the standard procedure for gastric cancer treatment. Of these patients, 34 underwent D3 lymphadenectomy, and chyloperitoneum was detected in 4 of them. Results There were three male patients and one female patient. All patients were in stage III according to the International Union Against Cancer (UICC)-TNM classification. In three patient, chyle leakage was noticed during the surgery, and surgical ligation of the duct was performed. Abdominal distension developed in one patient 7 days after the surgery, and chylous ascites was diagnosed. This patient was success-fully treated with fasting and total parenteral nutrition, within 2 weeks. Conclusion The incidence of chyloperitoneum is not low, and may increase with more aggressive surgery. Surgeons should be aware of this complication after retroperitoneal lymph node dissection, and injured lymphatics must be controlled and ligated intraoperatively.

Congenital chylous ascites is a rare condition seen in the neonatal period and the data on pathogenesis and treatment modalities are limited. In this article, we report a case of neonate with chylous ascites and review the therapeutic management procedures on chylous ascites in childhood. We present our experience in the diagnosis and treatment of this condition.Conclusion:  Medium-chain triglycerides (MCT)-based diet can be tried as a first option in chylous ascites treatment. In resistant or unresponsive cases, somatostatin along with TPN can have use in closing the lymphatic leakage or relieving the symptoms effectively and rapidly. Conventional regimens including enteral feeding with MCT-based formula can then be re-administered as a maintenance treatment after reduction of lymph flow with the use of total parenteral nutrition (TPN) and somatostatin infusion combination. Patient-specific approach should be attempted for chylous ascites caused by various disorders and started as soon as possible.