Published online Jan 27, 2025. doi: 10.4254/wjh.v17.i1.100797
Revised: October 15, 2024
Accepted: November 18, 2024
Published online: January 27, 2025
Processing time: 132 Days and 19.6 Hours
Chylous ascites is an uncommon condition, occurring in less than 1% of ascites cases. It results from traumatic or obstructive disruption of the lymphatic system, causing the leakage of thoracic or intestinal lymph into the abdominal cavity. This leads to the accumulation of a milky, triglyceride-rich fluid. In adults, malignancy and cirrhosis are the primary causes of chylous ascites. Notably, chylous ascites accounts for only 0.5% to 1% of all cirrhosis-related ascites cases. At present, there is a limited understanding of this condition, and effective timely management in clinical practice remains challenging.
This case report presents a patient with hepatic cirrhosis complicated by chylous ascites, who had experienced multiple hospitalizations due to abdominal distension. Upon admission, comprehensive examinations and assessments were conducted. The treatment strategy focused on nutritional optimization through a low-sodium, low-fat, and high-protein diet supplemented with medium-chain triglycerides, therapeutic paracentesis, and diuretics. Following a multidisciplinary discussion and thorough evaluation of the patient’s condition, surgical indications were confirmed. After informing the patient about the benefits and risks, and obtaining consent, a transjugular intrahepatic portosystemic shunt procedure was performed, successfully alleviating the abdominal swelling symptoms. This article details the clinical characteristics and treatment approach for this uncommon case, summarizing current management methods for hepatic cirrhosis complicated by chylous ascites. The aim is to provide valuable insights for clinicians encountering similar situations.
Optimizing nutrition and addressing the underlying cause are essential in the treatment of chylous ascites. When conservative approaches prove ineffective, alternative interventions such as transjugular intrahepatic portosystemic shunt may be considered.
Core Tip: This article presents a case of a patient with cirrhosis complicated by chylous ascites who experienced suboptimal outcomes despite adhering to conventional treatments, including a low-salt, low-fat, high-protein diet, diuretics, and abdominal paracentesis with catheter drainage. Ultimately, the patient’s condition was successfully managed through a transjugular intrahepatic portosystemic shunt procedure. The treatment approach described in this case may provide valuable insights for managing similar cases in clinical practice.