SHM Converge Scientific Abstract ePoster Gallery-Got Milk(y Ascites)? A Rare Case of Chylous Ascites

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This case describes a rare complication of necrotizing pancreatitis: <strong>chylous ascites</strong>, which occurs when lymph leaks into the peritoneal cavity and causes <strong>milky, triglyceride-rich ascitic fluid</strong>. In this patient, ascitic fluid had <strong>triglycerides of 424 mg/dL</strong>, confirming the diagnosis.

The report emphasizes that chylous ascites is uncommon and most often caused by <strong>trauma, malignancy, or cirrhosis</strong> in developed countries, while <strong>tuberculosis and filariasis</strong> are more common causes in developing regions. In necrotizing pancreatitis, the presumed mechanism is <strong>severe inflammation damaging the thoracic duct or abdominal lymphatic vessels</strong>.

Important complications of chylous ascites include:
- <strong>Dehydration</strong>
- <strong>Electrolyte imbalance</strong>
- <strong>Malnutrition</strong>
- <strong>Immune suppression</strong>

Overall, the condition is considered highly morbid and has been associated with a poor prognosis.

Management is difficult when the underlying cause cannot be quickly corrected. Two possible treatments discussed are:
1. <strong>Parenteral nutrition with medium-chain triglycerides (MCTs)</strong>, which bypass lymphatic absorption
2. <strong>Octreotide</strong>, sometimes used in combination with nutrition therapy

Other supportive measures may include <strong>serial paracentesis</strong> and <strong>diuresis</strong> for symptom relief. In this case, the patient improved only partially with paracentesis and diuresis, continued enteral MCT nutrition, and did not receive octreotide due to uncertain benefit. The authors stress that clinicians should keep a high index of suspicion for chylous ascites in patients with severe necrotizing pancreatitis and new ascites.

Asset Subtitle

Jessica S. Fuller

Meta Tag

Author List Jessica S. Fuller, Sydney Power

Category Clinical Vignettes

Concept Chylous Ascites

Concept Necrotizing Pancreatitis

Concept Triglycerides

Concept Milky Fluid

Concept Medium-Chain Triglyceride Diet

Distinguished Non-Finalist

Presenter Organization University of North Carolina - Chapel Hill

Presenting Author Jessica S. Fuller

Track Adult

Keywords

chylous ascites

necrotizing pancreatitis

milky ascitic fluid

triglyceride-rich fluid

thoracic duct injury

lymphatic leakage

medium-chain triglycerides

octreotide

serial paracentesis

malnutrition

Chylous Ascites

Necrotizing Pancreatitis

Triglycerides

Milky Fluid

Medium-Chain Triglyceride Diet