Case Report
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World J Gastroenterol. Apr 28, 2012; 18(16): 1987-1990
Published online Apr 28, 2012. doi: 10.3748/wjg.v18.i16.1987
Acute chylous peritonitis due to acute pancreatitis
Georgios K Georgiou, Haralampos Harissis, Michalis Mitsis, Haralampos Batsis, Michalis Fatouros
Georgios K Georgiou, Haralampos Harissis, Michalis Mitsis, Haralampos Batsis, Michalis Fatouros, Department of Surgery, University Hospital of Ioannina, 45500 Ioannina, Greece
Author contributions: Georgiou GK, Harissis H, Mitsis M and Batsis H participated in the operation; Harissis H and Fatouros M supervised the compilation of this article; the article was written by Georgiou GK and Harissis H.
Correspondence to: Georgios K Georgiou, MD, Department of Surgery, University Hospital of Ioannina, Stavros Niarchos avenue, 45500 Ioannina, Greece. georgkgeorgiou@yahoo.com
Telephone: +30-26510-99769 Fax: +30-26510-99769
Received: June 17, 2011
Revised: December 7, 2011
Accepted: March 10, 2012
Published online: April 28, 2012
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.

Keywords: Chylous ascites; Chyloperitoneum; Chyle; Peritonitis; Pancreatitis