The Surgical Significance of Chylous Ascites

Vasko, John S.

doi:10.1001/archsurg.1967.01330150031006

Cited by 131 publications

(65 citation statements)

References 32 publications

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“…1-2 The incidence of the condition has always been underestimated, and is thought to be between 1 in 50,000 and 1 in 100,000 hospital admissions. 3 Congenital chylous ascites is even rarer, but is the most frequent cause of nonimmunologic peritoneal effusion. More than 10 studies have been reported in the last few years.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18][19][20] Congenital chylous ascites is due to an inadequate lymphatic drainage from the intestine, resulting from maldevelopment of the intra-abdominal lymphatic system. 3,12,21 The pathogenesis is poorly understood and genetic factors are discriminated. Consanguinity is a common feature, 22,23 and the male is more liable to the condition.…”

Section: Discussionmentioning

confidence: 99%

“…5,20,30 In utero, evacuation of peritoneal fluid can be indicated in fetal distress. 3,5 After a 10-week trial of bowel rest, most authors agree on abdominal exploration. 37 Further imaging studies should also be considered-Tc 99m dextran lymphoscintigraphy, 38,39 lymphangiogram or preoperative ingestion of the lipophylic dye 40 can direct the surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

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Congenital Chylous Ascites: Report of Four Cases and Review of the Literature

et al. 2000

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Congenital Chylous Ascites: Report of Four Cases and Review of the Literature

et al. 2000

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“…Embolic occlusion of subclavian vessels, nephritis, filariasis, bilharziasis and thoracic duct obstruction by aneurysm are other conditions that have been reported to be associated with chylous effusions. 3 There is a high incidence of patients, such as the case described, in whom etiology is not determined, either at surgical exploration, or at postmortem examination.…”

Section: Differential Diagnosis Of Milky Peritoneal Fluidmentioning

confidence: 92%

“…It is bacteriostatic, sterile on culture, and resists putrefaction. 3 Pseudochyle is an opalescent chyle-like fluid aspirated from patients with widespread peritoneal seedling of malignant neoplasm. The opalescence is due to degenerated cells or substances of a lecithin globulin character.…”

Section: Differential Diagnosis Of Milky Peritoneal Fluidmentioning

confidence: 99%

Acute Chylous Peritonitis Simulating Acute Appendicitis: A Case Report and Review of the Literature

Fazili

Khawaja

1999

Ann Saudi Med

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Chylous effusions into pleural and peritoneal cavities are unusual, and are often a manifestation of an underlying disease process. A sudden outpouring of chyle into the peritoneal cavity may, on rare occasions, produce acute chylous peritonitis. Such patients usually present with features of acute abdomen, however, the diagnosis is rarely suspected preoperatively. Very few cases of acute chylous peritonitis have been described in the literature, and to the best of our knowledge, this is first of its kind in Saudi Arabia. Due to its rarity and presentation as compared to a common surgical emergency such as acute appendicitis, the clinical features and management of acute chylous peritonitis are discussed. Case ReportA 25-year-old Nigerian male was referred to the emergency room of King Fahad Hospital, in Medina, Saudi Arabia, because of generalized abdominal pain, vomiting and anorexia of three days' duration. The pain had started as a dull ache just above the umbilical region, had gradually increased in severity and become generalized. A day prior to his admission, the pain had localized to the right lower quadrant of the abdomen. The pain was continuous, severe and aggravated by any movement. The patient did not give any history of previous trauma or similar pain. He had been unable to take anything orally for over 24 hours prior to admission. There was nothing relevant in his past medical history, except that five years previously, he had been hospitalized for respiratory infection for five days. Details of this were not available. For the previous six years, the patient had been smoking about thirty cigarettes per day. He had not consumed alcohol for the past two years. There was no history of diabetes, hypertension, hyperlipidemia or recurrent abdominal pains in his family.On examination, the patient was mildly dehydrated. His temperature was 37.5°C, pulse rate was 115/min, and blood pressure was 110/85 mm Hg. Systemic examination was unremarkable. The abdomen was not moving adequately with respiration, and there was pain on coughing, especially in the right lower quadrant. The flanks were not full. There was guarding and tenderness all over the abdomen, especially in the right iliac fossa. Bowel sounds were audible. Total leukocyte count was 20,000/μL, Hb 16.8 g%, urea 4.3 mmol/L, creatinine 87.9 mmol/L, glucose 4.6 mmol/L, ALT 22 IUL, AST 28 IUL, amylase 104 IUL, cholesterol 3.5 mmol/L and triglycerides 0.34 mmol/L. Chest x-ray was normal. Abdominal x-ray showed nonspecific gas-filled loops of large intestine. The patient was suspected to have acute appendicitis with possible perforation.The abdomen was opened by right grid-iron incision, revealing unusually pale and white subcutaneous fat. The epimysium over the fibrous sheath aponeurosis of external oblique showed multiple strands with an interwoven network of whitish streaks. Between the strands was a whitish thickening of 1-2 mm. When the peritoneum was opened, milky white, odorless, non-clotting fluid gushed out. About one liter of this fluid was dra...

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Chylous Ascites

Lesser¹

1970

Arch Intern Med

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When a condition appears rarely and sporadically, few clinicians have the opportunity to collect adequate information and to develop interest and expertise. Such is the case with chylous ascites and, as a result, many aspects of this phenomenon remain poorly understood. The pathophysiology has not been clearly defined, the underlying disease often proves elusive with present diagnostic procedures, and effective therapy is frequently not possible. The incidence has not been satisfactorily established; at Charity Hospital of Louisiana, New Orleans, there was approximately one patient per 100,000 admissions from 1936 to 1956.1 The actual occurrence of chylous ascites is probably higher, as the condition is usually unsuspected; the patient may die or the process resolve without the presence of the condition being revealed by paracentesis. In addition, the incidence is probably not constant, and is likely to vary as etiological factors vary with geographical area (eg, filariasis) or with the prevalence of certain diseases (eg, tuberculosis).Chylous ascites or chyloperitoneum is a manifestation or symp¬ tom and not a disease entity. It is the collection within the peritoneal cavity, as a result of interference, interruption, or obstruction of lymph flow through chyle-transporting ves¬ sels, of fluid which appears milky due to the presence of unusual amounts of fat. The fat occurs pri¬ marily as triglycérides, usually with associated small amounts of choles¬ terol and phospholipids.1"3 The cri¬ teria often used to define a chylous effusion are a lipid content greater than that of plasma, a protein con¬ tent more than half that of plasma, and the presence of microscopic fat.These criteria cannot be rigidly maintained since exceptions can be found to each of them. Microscopic fat may be absent 4 ; its presence is a function of the physical state of sus¬ pended lipids. Fat and protein con¬ centrations are dependent upon dietary as well as other factors, and considerable variation might be anticipated. Effusions of unquestion¬ able chylous origin have, upon oc¬ casion, been shown to contain <2 gm/100 ml of protein and <350 mg/ 100 ml of lipid.2"" However, the neu¬ tral fat : total lipid ratio is almost universally higher than that of plas¬ ma.2-5 The only lymphatic fluids ap¬ proaching these high contents of fat and protein are those drained from the intestine and possibly the liver; the similar relative composition of chylomicrons suggests the origin of the effusion.In view of this it is useful to ex¬ amine some pertinent aspects of lipid digestion and absorption. About one third of dietary triglycérides are termed medium and short chain (MCT) ; these are composed of fatty acids with fewer than 12 carbon atoms (largely caprylic, capric, lauric, and caproic acids). These tri¬ glycérides probably enter the intes¬ tinal wall intact, are broken down within the cell, and the resultant free fatty acids and glycerol are transported directly to the liver by the portal vein. Pancreatic enzymes are not required for digestion and abs...

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The Surgical Significance of Chylous Ascites

Cited by 131 publications

References 32 publications

Congenital Chylous Ascites: Report of Four Cases and Review of the Literature

Congenital Chylous Ascites: Report of Four Cases and Review of the Literature

Acute Chylous Peritonitis Simulating Acute Appendicitis: A Case Report and Review of the Literature

Chylous Ascites

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