Chyloperitoneum: an unusual diagnosis of acute abdomen

Abstract

Chylous ascites or chyloperitoneum is the extravasation of milky chyle rich in triglycerides (> 200 mg/ dL) into the peritoneal cavity. The etiology includes congenital anomalies, neoplastic obstructions and trauma in abdominal lymph vessels; yet, 50% of the cases are idiopathic.
We report the case of a 40-year-old woman with sudden, acute back pain and no other signs or symptoms who evolved with abdominal pain and distension. The computed tomography scan detected free intra-abdominal and retroperitoneal fluid. An exploratory video-assisted laparoscopy revealed free intra-abdominal fluid with a cloudy milky-white appearance. The peritoneal cavity and retroperitoneal space were washed and a drain was placed.
Peritoneal fluid analysis confirmed the diagnosis of idiopathic chylous ascites. Treatment with highprotein, low-fat enteral feeding supplemented with medium-chain triglycerides was initiated, with favorable outcome. The laparoscopic approach allowed for confirmation of the diagnosis and exclusion of associated lesions.