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Management of Idiopathic Infantile Chylous Ascites

Henry Zou1, James Van Beynen2, Joshua Ritzema1

  • 1Pediatrics, Michigan State University College of Human Medicine, Grand Rapids, USA.

Cureus
|April 11, 2024
PubMed

Insights

Chylous ascites, the buildup of lymphatic fluid, can be challenging to diagnose in infants. This case demonstrates successful management using a combination of conservative and surgical approaches for pediatric chylous ascites.

Area of Science:

  • Pediatric Gastroenterology
  • Neonatal Surgery
  • Lymphatic Physiology

Background:

  • Chylous ascites involves triglyceride-rich lymphatic fluid accumulation in the peritoneal cavity.
  • Identifying the precise etiology of pediatric chylous ascites remains a clinical challenge.

Observation:

  • A four-month-old male presented with abdominal distension and confirmed ascites.
  • Imaging revealed a large volume of ascites; paracentesis confirmed a chylous aspirate.
  • The infant underwent pigtail catheter drainage and received total parenteral nutrition.

Findings:

  • Abdominopelvic MRI showed minimal residual ascites without evidence of lymphatic malformation.
  • The patient tolerated transitioning from parenteral to nasogastric feeding.
  • This case highlights diagnostic limitations and effective multimodal management strategies.

Implications:

  • Management of pediatric chylous ascites requires a tailored approach combining conservative and surgical interventions.
  • Early diagnosis and intervention are crucial for optimizing outcomes in neonates with chylous ascites.
  • Further research is needed to improve the diagnostic accuracy for the underlying causes of chylous ascites in infants.

Keywords:
chylous ascitescongenital lymphatic malformationdrainageparacentesistotal parenteral nutrition

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