Chyloperitoneum in Newborns: Etiology, Pathogenesis, Diagnostics and Treatment

Abstract

The present article is a literature review on etiopathogenesis, diagnosis, conservative and surgical treatment of chyloperitoneum in newborns. Chyloperitoneum is an extremely rare pathology in children and, not in all cases it is possible to find its cause. The management protocol for chyloperitoneum has not been developed. The most effective approach for managing this disease is a starvation pause, than transfer to full parenteral nutrition, administration of somatostatin (octreotide) and drainage of the abdominal cavity. Conservative therapy may take several months and, its effectiveness reaches 60-100%. Surgical treatment is aimed to indentify a focus of lymph leakage and its elimination; in severe cases, the fibrin glue is used.

Somatostatin analog (octreotide) and sirolimus immunosuppressive therapy in the treatment of chyloperitoneum and chylothorax in newborns and infants

“…In infants and small children, lymphography is not feasible due to technical challenges and potential serious side effects. [4] Lymphatic vessels identified intraoperatively can be successfully sutured, yielding positive outcomes in 85% of cases. However, when the source of lymphorrhea is unclear or multiple defects are present, fibrin glue may be used, although it carries the risk of causing severe adhesive processes or inadvertently entering the bloodstream.…”

“…[12] However, the most effective approach to reducing lymph production is total parenteral nutrition. [2,4,5] Some authors propose a duration of parenteral nutrition for 3-4 weeks. [13,14] Yet, it is crucial to consider the associated elevated risks of liver disorders, intestinal atrophy, and infections stemming from the use of a central venous catheter or drainage tube.…”

“…[13,14] Yet, it is crucial to consider the associated elevated risks of liver disorders, intestinal atrophy, and infections stemming from the use of a central venous catheter or drainage tube. [4,13,14] Neonates who were not fed from birth may exhibit a negligible increase in triglycerides in drainage discharge. [2] In current literature, the administration of somatostatin (octreotide) is described as the most common conservative treatment.…”

“…Although exact guidelines are not standardized, the treatment period is individualized for each patient and can range from 1 to 8 weeks. [4,6,9,15,16] This approach is generally not associated with severe complications, except for rare cases of necrotizing enterocolitis resulting from ischemic disorders of the intestine. [17] However, further research on safety is warranted.…”

“…Their management is very tricky and ranges from simple drainage to drug therapy or even surgical interventions. [4][5][6][7][8][9][10] Our study aims to share our experience of treating CP/CT in newborns using octreotide and sirolimus.…”