Resolution of chyloperitoneum in a preterm with octreotide, diet and cessation of dialysis

Abstract

The diagnosis of chyloperitoneum (CP) is based on the presence of high levels of triglycerides (TGs) in the dialysate. It is a rare complication of peritoneal dialysis (PD) and even rarer in neonates. We report here the case of CP in a 1700-g male baby delivered at the 30th gestational week due to posterior urethral valve and associated oligohydramnios. On postnatal day 2, the serum creatinine (Scr) was 1.6 mg/dL, and he was anuric. PD was instituted via a Tenckhoff catheter. At the end of the second week, after the initiation of enteral feeding, the ultrafiltrate became cloudy, with a leukocyte count of 900/mm(3). A treatment regimen consisting of intraperitoneal vancomycin and ceftazidime was then started. Five days later, the fluid became milky, with a TG level of 251 mg/dL. The patient was then placed on a diet based on medium-chain triglycerides and octreotide (1 microg/kg/h; increasing up to 2 microg/kg/h over 15 days). Although the TG and leukocyte levels decreased, the milky appearance persisted. PD was stopped for 2 days when the Scr decreased to 1.7 mg/dL. When it was resumed, the fluid was totally clear, with a TG level of 7 mg/dL. The infant was discharged with a nightly intermittent peritoneal dialysis program and has had no recurrence. In summary, we report a preterm infant who developed CP during PD and recovered following treatment that included diet modification, octreotide, and temporary discontinuation of the PD.

Coexistence of Congenital Chylous Ascites and Congenital Hypothyroidism: Case Report

“…The efficiency of octreotide together with diet has been proven in CA treatment. [1][2][3] Diet is one of the most important steps in the treatment of chylous ascites. Normally, while long-chain triglycerides (LCT) are directly absorbed into the lymphatic system, MCT bypasses the lymphatic system and is absorbed into the portal system directly from the intestines.…”

“…If the amount of LCT in the diet is decreased and the amount of MCT is increased, lymphatic flow decreases and time is gained to heal the underlying pathology naturally. [1][2][3]8,9 However, with the concern that prolonged use of low-LCT diet can affect neurological development negatively, it is suggested that this diet should be restricted to 3-4 months. 2,8,9,13 Another treatment alternative in heavy or diet resistant CA cases is total parenteral nutrition (TPN).…”

“…7 The majority of pediatric CA cases (45-70%) are congenital or idiopathic lymphatic abnormalities. 1,2,8,9 Besides, intussusception, intestinal malrotation, incarcerated hernia, obstructive lesions, traumas, peritoneal dialysis, liver cirrhosis, malignancy, surgical injuries, tuberculosis and other inflammatory peritoneal infections may be considered. 1,2,[8][9][10][11][12] The definitive diagnosis of CA depends on paracentesis.…”

“…1,2,8,9 Besides, intussusception, intestinal malrotation, incarcerated hernia, obstructive lesions, traumas, peritoneal dialysis, liver cirrhosis, malignancy, surgical injuries, tuberculosis and other inflammatory peritoneal infections may be considered. 1,2,[8][9][10][11][12] The definitive diagnosis of CA depends on paracentesis. 2,8 The most important feature of the fluid drawn by paracentesis is that it is rich in lymphocytes, protein and chylomicrons.…”

“…The most common cause of CA diagnosed in newborns is congenital malformation of lymphatic ducts. 1,2 The efficiency of octreotide together with diet has been proven in CA treatment. [1][2][3] Diagnosis of congenital hypothyroidism is generally made with newborn screenings.…”