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Acute Chylous Ascites Status Post Median Arcuate Ligament Syndrome Decompression: A Unique Case Report and Literature
Leo Sakai1, Paul Aguilera1, Sathish Karmegam1
1Internal Medicine, Medical City Denton, Denton, USA.
Insights
Chylous ascites (CA), a rare condition with triglyceride-rich fluid, can occur after abdominal surgery. This case highlights postoperative CA following median arcuate ligament syndrome decompression.
Area of Science:
- Gastroenterology
- Surgical Complications
Background:
- Chylous ascites (CA) involves triglyceride-rich peritoneal fluid, with malignancy, cirrhosis, and surgical trauma as common causes in adults.
- No established clinical guidelines exist for managing chylous ascites.
Observation:
- An 18-year-old female presented with abdominal pain and distention post-median arcuate ligament syndrome (MALS) decompression.
- Computed tomography revealed significant ascites; paracentesis confirmed milky, triglyceride-rich fluid.
- The patient's recent MALS decompression surgery was identified as the cause of acute CA.
Findings:
- Postoperative chylous ascites occurred as a complication of median arcuate ligament syndrome decompression.
- Ascitic fluid analysis confirmed high triglyceride levels, indicative of chylous ascites.
Implications:
- This case underscores the varied etiologies of ascites, including surgical complications.
- Emphasizes the critical role of thorough patient history and physical examination in diagnosing ascites.
- Highlights the need for considering surgical complications in the differential diagnosis of chylous ascites.
Abstract:
Chylous ascites (CA) are a rare finding of triglyceride-rich peritoneal fluid within the abdominal cavity. Malignancy, cirrhosis, and trauma after abdominal surgery are the leading causes of CA in adults. Currently, there are no published guidelines on the management of CA. This report describes a case of an 18-year-old female presenting with abdominal pain and distention following median arcuate ligament syndrome (MALS) decompression. A computed tomography (CT) of the abdomen and pelvis showed large-volume ascites with normal hepatic morphology. Paracentesis and ascitic fluid studies were positive for milky fluid rich in triglyceride. Her recent history of MALS decompression revealed the cause of her acute CA to be a postoperative complication from her abdominal surgery. This case highlights the diverse etiology of ascites and the importance of a careful history and physical examination when evaluating adults with ascites.
