Chylous Ascites in Advanced Gallbladder Cancer
Mallika Tewari1, Rupesh Singh2, H S Shukla2
1Hepatopancreatobiliary and Gastrointestinal Division, Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P. 221005 India ; Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P. 221005 India.
The Indian Journal of Surgery
|December 21, 2016
Summary
This case report details a rare instance of chylous ascites in a patient with gallbladder cancer (GBC). Management involved a medium-chain triglyceride diet and diuretics, leading to a successful recovery.
Area of Science:
- Gastroenterology
- Oncology
- Surgical Pathology
Background:
- Chylous ascites is an uncommon condition characterized by the accumulation of lymphatic fluid in the abdominal cavity.
- Gallbladder cancer (GBC) rarely presents with chylous ascites, with only six previous cases documented in medical literature.
Purpose of the Study:
- To report a unique case of chylous ascites secondary to gallbladder cancer.
- To discuss the diagnostic and management strategies for this rare clinical presentation.
Main Methods:
- A 55-year-old female patient presented with abdominal pain and was diagnosed with gallbladder cancer via contrast-enhanced computed tomography (CECT).
- Laparotomy revealed milky ascites and engorged lymphatics; biopsy confirmed metastatic adenocarcinoma.
- Ascitic fluid analysis showed elevated triglyceride levels (817.00 mg/dl).
Main Results:
- Histopathology confirmed metastatic adenocarcinoma in the lymph nodes, establishing gallbladder cancer as the cause of chylous ascites.
- The patient's triglyceride levels in ascitic fluid were significantly elevated.
- Conservative management, including a medium-chain triglyceride diet and diuretics, resulted in clinical improvement and successful discharge.
Conclusions:
- Chylous ascites can be a rare but significant manifestation of advanced gallbladder cancer.
- Prompt diagnosis and conservative management, including dietary modifications, are crucial for patient recovery.
- Further research into the mechanisms and optimal treatment of malignancy-associated chylous ascites is warranted.
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