During the management of acute abdominal disease, the intraoperative gross findings assume paramount importance in surgical decision making. Frequently and fortunately, histopathologic confirmation of the disease process is not required to dictate the choice of management options and the operative diagnosis is usually unmistakably correct. Experience of the operating surgeon, coupled with the frequent incidence of these acute abdominal conditions, facilitate their diagnostic accuracy. In this communication, the salient clinicopathologic features of acute chylous peritonitis, a rare condition in which the intraoperative findings can be essential in calling attention to the presence of the disease, are summarized