Chylous ascites

Chylous ascites usually occurs when there is massive obstruction of abdominal lymphatic drainage. It is a milky white ascites, rich in chylomicrons from mesenteric lymphatics.

It is usually secondary to malignant involvement of the para-aortic lymph nodes by lymphoma or metastatic testicular tumour.

Less frequently, it is caused by:

• primary fistula - the fistula should be closed with nonabsorbable sutures
• primary lymphatic disease
• other secondary causes:
  • postradiation obstruction
  • postoperative - very rarely

Treatment is surgical. Primary fistulas where present should be closed with nonabsorbable sutures. When surgery is unsuccessful, a Leveen peritoneal venous shunt should be employed to return accumulated peritoneal lymph to the central circulation.

Reference

1. Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Aug;74(2):1014-48.