Successful Management of Congenital Chylous Ascites in a Premature Infant Using Somatostatin Analogue

Abstract

Congenital chylous ascites (CCA) is a rare disease defined as the accumulation of chylomicron-rich lymphatic fluid within the peritoneal cavity, resulting from maldevelopment of the intra-abdominal lymphatic system. Cases unresponsive to conservative treatment usually require surgical intervention. We report a case of CCA in a premature neonate, who was treated successfully with intravenous infusion of octreotide, a synthetic somatostatin analogue after failure to response to traditional supportive therapies.

Congenital chylous ascites treated successfully with MCT-Based formula and octreotide

“…[6] Since its first successful use to treat the chylous effusion by Caty et al ., marked variation were found regarding its dosing regimen, modes of drug administration and duration of treatment in the existing literature. [26789] We started continuous intravenous of octreotide initially at a rate of 1μg/kg/hr, gradually step-up to 2μg/kg/hr, continued in tapering doses from day 5 and finally stopped on day 10. A dramatic response was observed within 72 hrs of infusion, with complete resolution of ascites by 10th day after treatment.…”

Successful management of congenital chylous ascites with early octreotide and total parenteral nutrition in a newborn

“…To the best of our knowledge, only six case reports have been published on somatostatin analogue treatment of CCA 1 2 6–9. Of these, in two cases the treatment with octreotide failed resulting in surgical intervention 8 9.…”

“…According to the literature, TPN allows resolution of chylous ascites within 2–6 weeks5 10; whereas in all the cases in which octreotide treatment was successful, the duration of therapy ranged from 1 to 3 weeks 1 2 6 7…”

Management of Chylous Ascites with Octreotide in a Bangladeshi Child: A Case Report

“…Octreotide has become popular drug for the treatment of chylous ascites because of its ease in administration, low invasiveness, short treatment time and its high effectiveness. 8 Here, we report a case of CCA in a child successfully treated with octreotide.…”

“…In addition, variationsregarding octreotide dosing regimens (0.5-8 mcg/kg/h), modes of drug administration (intravenous or subcutaneous), commencement and duration of treatment have beenreported in the literature. 15,16 We used octreotide by intravenous infusion at a rate of 0.5ìg/kg/h and gradually increased to 1 ìg/kg/h on day 3 and continued till day 7 then tapered and discontinued on day 10.Huanget al 8 also used same dose and duration. A dramatic decrease in chyleproduction was observed within 24 hours of infusion, with complete resolution of ascites by 10…”