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Neonatal ascites
Published in Prem Puri, Newborn Surgery, 2017
Chylous ascites is a rare condition seen during the newborn period and infancy; however, it is a challenging disorder with regard to its successful treatment. 15,16 Generally, it presents with abdominal distension with or without respiratory distress and occasional signs of peritoneal irritation and malabsorption.17 About 10% of all infants with chylous ascites have lymphedema of the limbs.18 The most common cause of chylous ascites (45%–60% of cases) is congenital malformation of the lymphatic channels such as atresia or stenosis of the major lacteals, mesenteric cysts, and generalized lymphangiomatosis. 16,19 Other causes are obstruction of the lymphatics from external compression, as in malrotation; incarcerated hernia; intussusception; and inflammatory enlargement of lymph nodes. Furthermore, blunt abdominal trauma, child abuse, and surgical injury are reported causes of chylous ascites.20
Medical and open surgical management of chylous disorders
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
Ying Huang, Audra A. Duncan, Gustavo S. Oderich, Peter Gloviczki
Browse et al.17 reported on a series of 45 patients with chylous ascites. The age at presentation ranged from 1 to 80 (median 12) years; 23 patients were aged 15 years or younger. Thirty-five patients had an abnormality of the lymphatics (primary chylous ascites); in 10, the ascites was secondary to other conditions, principally non-Hodgkin’s lymphoma (six patients). Other associated lymphatic abnormalities were present in 36 patients, with lymphedema of the leg being the most common (26 patients). All patients were initially treated conservatively with dietary manipulation, with best results in patients with leaking small bowel lymphatics. Surgery (fistula closure, bowel resection, or insertion of a PVS) was performed in 30 patients. Closure of a retroperitoneal or mesenteric fistula, when present, was the most successful operation, curing seven of the 12 patients.17 In those patients who develop chylous ascites due to iatrogenic trauma, frequently after aortic reconstructions, a short period of conservative management is justified. If chylous ascites re-accumulates, reoperation with ligation of the fistula is the most effective treatment.
Ascites and Peritonitis
Published in John F. Pohl, Christopher Jolley, Daniel Gelfond, Pediatric Gastroenterology, 2014
Candi Jump, Douglas Moote, Wael N. Sayej
The most common cause for ascites in children is portal hypertension resulting from chronic liver disease (55.2, 55.3) or, less commonly, obstruction of hepatic vein outflow (as in Budd–Chiari syndrome) (Table 55.1). Other more common causes include pancreatitis, lymphatic obstruction, or trauma. Lymphatic disruption either from abdominal surgery, trauma, or neoplasms leads to chylous ascites (55.4, 55.5). Older children may also have traumatic extrahepatic perforation of the bile tree causing biliary ascites (55.6, 55.7). There have also been patients with ascites secondary to the following causes: right heart failure, constrictive pericarditis, intestinal necrosis (55.8), ventriculoperitoneal shunts (55.9, 55.10), intra-abdominal neoplasms such as lymphoma (55.11), Henoch–Schönlein purpura, Crohn disease (55.12, 55.13), and vitamin A toxicity.
High mortality in peritonitis due to Mycobacterium avium complex: retrospective study and systematic literature review
Published in Infectious Diseases, 2019
Aurélie Baldolli, Claire Daurel, Renaud Verdon, Arnaud de La Blanchardière
In this report, we found that PMAC was associated with chylous ascites in 54% of cases. Chylous ascites is defined as an abnormal accumulation of triglyceride-rich lymphatic fluid in the peritoneal cavity, which makes the fluid milky. It is caused by the interruption of the lymphatic flow at any point from the intestinal villi to the left brachiocephalic vein (triggers may include surgical injury of the lymphatics, radiotherapy, lymphoma, gastric cancer, carcinoid tumours, Kaposi sarcoma, sarcoidosis, tuberculosis, filariasis and Whipple’s disease), increased lymph production (causes may include cirrhosis and constrictive pericarditis) or congenital dilated lymphatic vessels (causes may include intestinal lymphangiectasia, Klippel–Trenaunay syndrome and lymphangioma) [16,20,23,34,36]. In this review, most of the patients with chylous ascites were HIV-infected (n = 15, 88%) and all instances of IRIS related to MAC infection involved chylous ascites. For these patients, chylous ascites was probably secondary to the involvement of the retroperitoneal lymph nodes or to the obstruction or damage of lymphatic drainage [23,40]. It is also well known that HIV-related abdominal MAC-IRIS is associated with histologically granulomas, suggesting that for these five patients the pathogenesis of chylous ascites may be related to granulomatous lymphadenitis causing lymphatic obstruction at the base of the mesentery or the cisterna chili [33,44,45]. Chylous ascites was not reported in CAPD with PMAC which can be explained by the pathway of inoculation through the dialysate.
Chylous Ascites in an Infant with Thanatophoric Dysplasia Type I with FGFR3 Mutation Surviving Five Months
Published in Fetal and Pediatric Pathology, 2018
Jeon Soo-kyeong, Narae Lee, Mi Hye Bae, Young Mi Han, Kyung Hee Park, Shin Yun Byun
Only a few reports in the literature have described cases of patients who have survived beyond the neonatal period. Stensvold et al. (20) reported a 169 day survival, Tonoki (21) reported a 212 day survival, and Noe et al. reported 4 months survival (22). Of the patients who survive into adulthood, Nakai et al. (23) reported survival of 23 years and Nikkel et al. (24) reported survival of 26 years. All patients exhibited distinct developmental delay, severe growth deficiency, dependence on a ventilator, and skin disorders such as seborrheic keratoses and acanthosis nigricans. In our case, the patient showed accompanying chylous ascites, which was not previously reported. The patient’s condition improved following the switch to the MCT formula. Accordingly, CT, lymphangiography, or lymph node biopsies were not performed. The patient had no medical history of abdominal surgery, injury, infection, or liver cirrhosis, which are known causes of chylous ascites. There was a possibility that the patient had congenital abnormalities, such as lymphangiectasia, mesenteric cyst, or idiopathic leaky lymphatics, which are the most common causes of chylous ascites in pediatric patients. However, we could not ascertain this as the patient’s parents refused autopsy. It is difficult to determine if the chylous ascites was part of the TD deformity or just happened to accompany the TD.
Chylous ascites as a complication of intraabdominal Mycobacterium avium complex immune reconstitution inflammatory syndrome
Published in Baylor University Medical Center Proceedings, 2018
Ryan K. Dean, Rogin Subedi, Ashraya Karkee
Chylous ascites is an abnormal accumulation and collection of lipid-rich lymphatic fluid in the peritoneal cavity. Its frequency in the general population is quite low.3,4 An abdominal paracentesis is the most important diagnostic tool in the evaluation of ascites. The appearance of chylous ascites is cloudy and turbid. Triglyceride levels are elevated, typically >200 mg/dL. Other features include an elevated cell count of >500 leukocytes/µL, showing lymphocytic predominance, and a low cholesterol level (with an ascites/serum ratio <1).5 Other important considerations include cytology, a tuberculosis smear, culture, and fluid adenosine deaminase measurements.