Chylous Ascites: A Rare Chronic Case

Chylous ascites (CA) is an uncommon form of ascites resulting from disruption or obstruction of the lymphatic system. Although cirrhosis and malignancy account for many cases in Western countries, management can be particularly challenging when the underlying etiology remains uncertain. We present the case of a 57-year-old man with chronic CA, longstanding unilateral right-sided lymphedema reportedly present since birth, and a prolonged clinical course spanning several years. Despite conservative management with diuretics, dietary modification, and repeated therapeutic paracenteses, the patient experienced recurrent symptomatic ascites and nutritional compromise. Ascitic fluid triglyceride testing supported the diagnosis of CA, and octreotide therapy was initiated. Although the patient's longstanding unilateral lymphedema raised concern for an underlying lymphatic abnormality, subsequent lymphangiography did not demonstrate a definitive lymphatic leak. A diagnosis of cirrhosis was also reported during a hospitalization abroad but was not confirmed by subsequent liver biopsy. The patient continues to require multidisciplinary management, including nutritional support, gastroenterology follow-up, and pharmacologic therapy, with a decrease in the frequency of therapeutic paracenteses. This case illustrates the diagnostic and therapeutic challenges of chronic CA when a definitive underlying etiology cannot be established and emphasizes the importance of comprehensive ascitic fluid analysis, nutritional optimization, and multidisciplinary evaluation in patients with persistent or refractory disease.