Atraumatic Chylous Ascites: Systematic Review on Symptoms and Causes

Steinemann, Daniel C.; Dindo, Daniel; Clavien, Pierre‐Alain; Nocito, Antonio

doi:10.1016/j.jamcollsurg.2011.01.010

Cited by 136 publications

(165 citation statements)

References 107 publications

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“…Endometrial cancer was reported only once as the cause of chylous ascites in 190 patients. 4 The rarity of this presentation justifies the search for other potential etiologies of chylous ascites in this patient, but only one primary malignancy was able to explain the clinical scenario. To the best of our knowledge, only one case of chylous ascites caused by endometrial carcinoma has been published.…”

Section: Discussionmentioning

confidence: 85%

“…It is defined as the accumulation of milky-appearing fluid containing high levels of triglycerides in the abdominal cavity. 4 Staats has pointed a triglyceride level greater than 110 mg/dL to be highly suggestive of chylous ascites, even though arbitrary values have been set by different authors. 5 On the other hand, Cárdenas et al have stated that ascitic fluid in chylaskos has the following characteristics: triglyceride level above 200 mg/dL, cell count above 500 with predominance of lymphocytes, total protein between 2.5 and 7.0 g/dL, SAAG below 1.1 g/ dL (except when cirrhosis is the cause of chylous ascites), LDH level between 110 and 200 IU/L and glucose level under 100 mg/dL.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Chylaskos as a presentation of serous papillary adenocarcinoma of the endometrium: a case report

Sequeira¹,

Borges²,

Camões³

2017

Gal. Clin.

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A 77-year-old female was presented to the emergency department with intense anorexia, weight loss despite progressive abdominal distension, and dyspnea. Abdomen imaging studies revealed moderate-volume ascites and a hepatic space-occupying lesion. Diagnostic paracentesis allowed the drainage of a chylous effusion and cytology analysis identified adenocarcinoma cells. Hepatic metastasis of papillary serous adenocarcinoma of the endometrium was confirmed after tomography-guided biopsy. Endometrial carcinoma is the most common malignant gynecological neoplasm in developed countries and is often classified in type I with endometrioid histology (estrogen-dependent) and non endometrioid type II (non-estrogen-dependent). Chylous ascites or chylaskos is a rare presentation on hospital admission. Several etiologies have been described. In adults, solid malignancy is expected to be identified in less than 20% of the cases. Currently only one case of endometrial carcinoma presenting with chylous ascites was described in a systematic review. Keywords: Chylous ascites, endometrial neoplasms Clinical caseA 77-year-old female was admitted in the Internal Medicine ward for investigation after presenting to the emergency department with intense anorexia, weight loss despite progressive abdominal distension and dyspnea. As past medical history, the patient related chronic gastritis, chronic microcytic anemia, arterial hypertension, dyslipidemia and type 2 diabetes mellitus with no vascular events, besides chronic kidney disease (stage 3). She denied any alcohol or smoke habits. On gynecological reports she had one term labor with eutocic delivery, menarche at 12 and menopause at 40 years, with no further complaints or bleeding discharge since then. Laboratory evaluation showed microcytic anemia (hemoglobin 7.4 g/dL, mean corpuscular volume 75.7 fL) with normal white cells and platelet count, mild hypoalbuminemia (31.6 g/L), normal serum total protein (67.7 g/L), normal serum transaminases ( aspartate aminotranferease 17 U/L, alanine aminotranferease 8 U/L) normal gamma glutamyl transpeptidase (30 U/L), alkaline phosphatase (110 U/l) and lactate dehydrogenase (228 U/L) values; high erythrocyte sedimentation rate (71 mm in the first hour) and a high C-reactive protein (64.3 mg/L), not changed baseline renal function (serum creatinine of 1.60 mg/dL with an estimated glomerular filtration rate of 35 mL/min/1.73 m2). Diagnostic paracentesis allowed the drainage of an exudative effusion. The laboratory analysis revealed 574 total cells with lymphocytes predominance (total protein of 51.9 g/L, albumin of 25.8 g/L, with a serum-to-ascites albumin gradient (SAAG) of 0.58 g/dL, lactate dehydrogenase level of 175 IU/L, glucose level of 126 mg/dL and triglyceride level of 382 mg/dL. It wasn´t detected any microorganism from the effusion. These chemistry results were consistent with a chylous effusion. Cytological analysis identified adenocarcinoma cells of unknown origin. Abdominopelvic magnetic resonance imaging revealed several hyp...

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Chylaskos as a presentation of serous papillary adenocarcinoma of the endometrium: a case report

Sequeira¹,

Borges²,

Camões³

2017

Gal. Clin.

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“…CA is a rare condition (1:20,000 admissions in general hospital, but 1:2,248 HIV hospital interments) 7 first described in 1691, which has a vast differential diagnosis, 15 such as trauma, post abdominal surgery, liver cirrhosis, cancer, infectious (tuberculosis, Mycobacterium avium complex, filariasis, paracoccidioidomycosis), 16 pancreatic, yellownail syndrome, lymphatic malformation, among others. Although lymphoma is frequently remembered in differential diagnosis of CA (expected frequency of 33-50% of all cases), recent review cites frequency of 8% among adult cases, 15 and in HIV population this frequency seems to be even lower.…”

Section: Discussionmentioning

confidence: 99%

“…Although lymphoma is frequently remembered in differential diagnosis of CA (expected frequency of 33-50% of all cases), recent review cites frequency of 8% among adult cases, 15 and in HIV population this frequency seems to be even lower. We reviewed the all 18 published cases of CA in HIV/ aids population, most of them (15/18, 83%) caused by infectious diseases, markedly tuberculosis and Mycobacterium avium complex, in highly immunocompromised patients (mean TCD4=87cell/mL, mean age=38yr-old) ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

Chylous ascites secondary to Hodgkin’s lymphoma in a HIV/aids patient: case report and literature review

Júnior

Leonídio

Lira

et al. 2017

Medicina (Ribeirão Preto)

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“…1 Steinemann and associates reported that liver cirrhosis leads to atraumatic chylous ascites in 11% of all adult patients. 2 They stated that increased intra-abdominal pressure may result in intra-abdominal leakage of lymphatic fluid. 2 Also, chylous ascites has been reported as a rare complication after liver transplant.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2014

Exp Clin Transplant

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Chylous ascites after a liver transplant is a rare complication of surgery. We report a 11-month-old girl with biliary atresia who was presented with chylous ascites after a liver transplant. On the seventh day after surgery, while being fed, chylous ascites was observed. Besides fasting and diuretics, total parenteral nutrition and somatostatin analogue (octreotide) were initiated. Chylous ascites resolved in 3 weeks. Abdominal distention recurred 1 week later; fasting and total parenteral nutrition, combined with octreotide, were administered again for 2 more weeks. Thereafter, enteral feeding was started without any complications.

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Atraumatic Chylous Ascites: Systematic Review on Symptoms and Causes

Cited by 136 publications

References 107 publications

Chylaskos as a presentation of serous papillary adenocarcinoma of the endometrium: a case report

Chylaskos as a presentation of serous papillary adenocarcinoma of the endometrium: a case report

Chylous ascites secondary to Hodgkin’s lymphoma in a HIV/aids patient: case report and literature review

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