Thoracic duct lymph in a patient with chylous ascites and a carcinoid tumor

An adult patient with both intraabdominal carcinoid tumor and chylous ascites underwent thoracic duct drainage in an attempt to relieve accumulation of intraabdominal fluid. After cannulation of the left cervical thoracic duct, lymph flow rate was normal (1.4ml/min) and 24 hours of drainage was without effect on the ascites. In contrast to the chylous nature of the ascitic fluid, however, thoracic duct lymph was non-chylous and its protein content was lower than that of the ascitic fluid. The administration of secretin intravenously increased both the flow and amylase content of thoracic duct lymph. These observations signify that the chylous ascitic fluid neither leaked from nor had access to thoracic duct lymph but originated instead from obstructed mesenteric lacteals.