An unusual case of chylous ascites: A case report

Abstract

Intestinal lymhangiectasia (IL) is a rare cause of intractable, but potential curable ascites. It is characterised by a dilation of the lymphatics of the mucosa, submucosa, or subserosa in the small intestine and subsequent loss of lymph fluid. The symptoms are edema, diarrhea, and chylous ascites. It has been considered a rare disease in children with congenital malformations, but has recently been diagnosed more frequently in adults. The latter is more often caused by a local obstruction of the lymph vessels. We report a case of primary IL in a 62-year-old man, who presented with chylous ascites, diarrhea, and edema. The symptoms dramatically improved with the recommended low-fat, protein-rich diet, supplemented with medium-chain triglycerides (MCT) and parenteral nutrition. After cessation of the parenteral nutrition the chylous ascites relapsed and the parenteral nutrition, MCTs and diet were reinitiated, but he did not need paracentesis anymore.

IL is now more frequently diagnosed, including asymptomatic cases being examined for other diseases. Therefore, it is important to be aware of this condition even in middle-aged patients since it can be treated and occationally cured.