Article

Acute chylous peritonitis due to acute pancreatitis.

Department of Surgery, University Hospital of Ioannina, 45500 Ioannina, Greece.
World Journal of Gastroenterology (Impact Factor: 2.55). 01/2012; 18(16):1987-90. DOI: 10.3748/wjg.v18.i16.1987
Source: PubMed

ABSTRACT We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse. The development of chylous ascites is usually a chronic process mostly involving malignancy, trauma or surgery, and symptoms arise as a result of progressive abdominal distention. However, when accumulation of "chyle" occurs rapidly, the patient may present with signs of peritonitis. Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation, appendicitis or visceral ischemia. Less than 100 cases of acute chylous peritonitis have been reported. Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis. This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis, and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis. The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer, since, due to hypertriglyceridemia, serum amylase values appeared within the normal range. Moreover, abdominal computed tomography imaging was not diagnostic for pancreatitis. Following abdominal lavage and drainage, the patient was successfully treated with total parenteral nutrition and octreotide.

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    ABSTRACT: INTRODUCTION: Acute chylous peritonitis, a rare condition, is defined as an abrupt chylous fluid accumulation in the peritoneal space in the absence of a significant underlying pathology. Diagnosis is difficult due to abrupt onset and accompanying acute abdomen signs. PRESENTATION OF CASE: Here we presented the case of a 32-year-old female patient who underwent laparoscopy due to acute abdomen findings and was diagnosed with acute chylous peritonitis. No underlying pathologies were detected, and only irrigation and drainage were applied. She was discharged unproblematically with a low-fat diet and somatostatin administration. No recurrence occurred, and no other pathologies were encountered during her 9-month visit. DISCUSSION: Chylous fluid accumulation is reported to arise from various etiological factors such as trauma, chronic liver diseases, tuberculosis, filariasis, radiation, abdominal aorta surgery, different peritoneal infection and extended lymph node dissections. We have presented an acute chylous peritonitis case that was admitted with acute abdomen findings and followed up and treated with laparoscopy. CONCLUSION: In conclusion, this case demonstrates the effectiveness of laparoscopy in acute abdomen cases in which a specific preoperative diagnosis cannot be made. Aspiration of the fluid and drainage comprise a sufficient therapy if a focus cannot be found. Postoperative somatostatin use may be beneficial.
    International journal of surgery case reports. 02/2013; 4(4):419-421.

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