Chylous Ascites Associated with Small Bowel Volvulus: Case Report on a Laparoscopic Diagnosis

This case describes a rare clinical situation of chylous ascites due to lymphatic obstruction in the setting of small bowel volvulus. A 32-year-old man presented with acute onset abdominal pain in the preceding 3 hours, associated with nausea and vomiting. He underwent a computed tomography (CT) scan which was concerning for an internal hernia involving the small bowel. On subsequent laparoscopy, milky fluid suggestive of chyle was found within the pelvis, along with a torted segment of the small bowel. The bowel was gently reduced with ease using atraumatic laparoscopic graspers. On closer examination, the mesenteric border of the torted small bowel had a white edge suggestive of lymphatic build-up. This case report highlights the pertinent clinical features associated with this clinical scenario, important for the laparoscopic gastrointestinal surgeon.