Chylous Ascites

Posted by e-Medical PPT Monday, October 18, 2010
Chylous ascites is the extravasation of milky chyle into the peritoneal cavity. This can occur de novo as a result of trauma or obstruction of the lymphatic system. Moreover, an existing clear ascitic fluid can turn chylous as a secondary event.Milky ascites is subdivided into 3 groups as follows:
* True chylous ascites - Fluid with high triglyceride content usually higher than 110 mg/dL.
* Chyliform ascites - Fluid with a lecithin-globulin complex due to fatty degeneration of cells
* Pseudochylous ascites - Fluid that is milky in appearance due to the presence of pus
In adults, chylous ascites is associated most frequently with malignant conditions. These conditions particularly include lymphomas and disseminated carcinomas from primaries in the pancreas, breast, colon, prostate, ovary, testes, and kidney. Inflammatory disorders, such as tuberculosis, can infrequently be associated with chylous ascites.In children, the most common causes are congenital abnormalities, such as lymphangiectasia, mesenteric cyst, and idiopathic "leaky lymphatics." Neoplasia is an uncommon cause of pediatric chylous ascites.
The incidence of spontaneous chylous ascites in patients with chronic liver diseases is estimated to be 0.5%. The lymphatics rupture spontaneously as a result of high portal pressures. Abdominal surgery is a common cause of chylous ascites. The surgical procedures most frequently associated with chylous ascites are resection of abdominal aortic aneurysm and retroperitoneal lymph node dissection.

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