Submission Type

Case Report


Introduction: Chylous ascites is the accumulation of chyle, a triglyceride and calorie-rich fluid, in the peritoneal cavity. It develops when the intra-abdominal lymphatics that contain chyle are damaged. It is a rare complication of liver cirrhosis that affects less than 1% of patients with this condition. Prompt identification may allow for treatment of associated caloric wasting.

Clinical Findings: A 52-year-old woman with alcohol-related cirrhosis and refractory transudative ascites presented for her second scheduled revision of a transjugular intrahepatic portosystemic shunt. She had confusion, constipation, worsening ascites, and severe malnutrition with muscle wasting (body mass index 12.6). The procedure was deferred, and the patient was admitted to the inpatient internal medicine service.

Clinical Course: The patient was initially treated with intravenous ceftriaxone for presumed spontaneous bacterial peritonitis. The peritoneal fluid was cloudy but did not show evidence of infection. Further testing of the peritoneal fluid revealed elevated triglycerides, indicating chylous ascites. The patient’s condition improved after large-volume paracentesis, lactulose, and supportive measures. However, she developed a rapid re-accumulation of ascites and, on hospital day 5, developed anorexia, somnolence, and hypotension. Tube feedings and broad-spectrum antibiotics for empiric sepsis treatment were started. Her condition continued to deteriorate, and she died on hospital day 7.

Conclusions: Chylous ascites may lead to a loss of dietary triglycerides that can exacerbate the malnutrition that is common in liver cirrhosis. Resultant loss of dietary triglycerides can exacerbate the malnutrition that is already common in liver cirrhosis. If chylous ascites is identified promptly, dietary changes and nutritional interventions can be implemented. However, lymph-specific imaging is often needed for accurate and definitive surgical treatment.



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