Chylous Ascites

Key Features

Essentials of Diagnosis

• Abdominal distention

• Edema

• Hypoalbuminemia

• Hypogammaglobulinemia

• Lymphopenia

General Considerations

• Neonatal chylous ascites may be due to congenital infection or developmental abnormality of the lymphatic system (intestinal lymphangiectasia)

• If the thoracic duct is involved, chylothorax may be present

• Later in life, chylous ascites

  • May result from

    • Congenital lymphangiectasia

    • Retroperitoneal or lymphatic tumors

    • Peritoneal bands

    • Abdominal trauma

    • Intestinal malrotation

    • Infection

  • May occur after cardiac or abdominal surgery

Clinical Findings

Symptoms and Signs

• Both congenital and acquired lymphatic obstructions cause

  • Chylous ascites

  • Diarrhea

  • Failure to thrive

• Abdomen is distended, with a fluid wave and shifting dullness

• Unilateral or generalized peripheral edema may be present

Differential Diagnosis

• Ascites due to liver disease

• Constrictive pericarditis

• Chronically elevated right heart pressure

• Malignancy

• Infection

• Inflammatory diseases causing lymphatic obstruction

• In the newborn, urinary ascites from anatomic abnormalities of the kidney or collecting system must be considered

Diagnosis

Laboratory Findings

• Hypoalbuminemia

• Hypogammaglobulinemia

• Lymphopenia

• Ascitic fluid contains lymphocytes and has the biochemical composition of chyle if the patient has just been fed; otherwise, it is indistinguishable from ascites secondary to cirrhosis

Treatment

• Supportive, consisting mainly of a high-protein diet and careful attention to infections

• Shunting of peritoneal fluid into the venous system is sometimes effective

• A fat-free diet supplemented with medium-chain triglycerides decreases the formation of chylous ascites

• Total parenteral nutrition may rarely be necessary

• Infusions of albumin generally provide only temporary relief and are rarely used for long-term management

Outcome

Complications

• Chylous ascites caused by intestinal lymphatic obstruction is associated with fat malabsorption and protein loss

• Intestinal loss of albumin may lead to edema

• Rapidly accumulating chylous ascites may cause respiratory complications

• Primary infections and malignancies causing chylous ascites may be life threatening

Prognosis

• In the neonate, congenital chylous ascites may spontaneously disappear following one or more paracenteses and a medium-chain triglyceride diet

References