Zeng Wen, Hu Yue, Feng Jun, Luo Xiaoli
Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Surgical Intensive Care Unit, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Transl Pediatr. 2021 Jan;10(1):188-193. doi: 10.21037/tp-20-258.
Chylous ascites refers to the accumulation of lymphatic fluid in the peritoneal cavity. The causes of chylous ascites are various, and commonly include traumatic injury and obstruction, which disrupt the lymphatic system. In addition, cardiothoracic surgery may injure the thoracic duct and lead to chylothorax. However, there are very few reported cases of isolated chylous ascites developing following cardiothoracic surgery. In this paper, we report a case of postoperative chylous ascites in a full-term neonate. The infant underwent cardiothoracic surgery via thoracotomy to repair total anomalous pulmonary venous connection coexisting with a persistent left superior vena cava on day of life 17, and there was a significant increase in abdominal girth on postoperative day 12 (day of life 29). Abdominal ultrasound revealed an 8 mm thick ascites without pleural effusion. Abdominal paracentesis was performed and the milky-white peritoneal fluid was positive for Sudan III staining and the chylous test. The triglyceride concentration of the ascitic fluid was 691 mg/dL and the concentration of protein was 39.4 g/L. Additionally, the ascitic fluid also contained 6 360×10/L of white blood cells, predominantly lymphocytes. These results suggested the infant developed chylous ascites. Conservative management with fasting and medium-chain triglycerides-based formula successfully resolved the chylous ascites without reoccurrence. We present our experience of this rare condition and discuss the possible causes of chylous ascites in this case.
乳糜性腹水是指腹腔内淋巴液的积聚。乳糜性腹水的病因多种多样，常见的包括创伤性损伤和梗阻，这些会破坏淋巴系统。此外，心胸外科手术可能会损伤胸导管并导致乳糜胸。然而，很少有报道称心胸外科手术后出现孤立性乳糜性腹水的病例。在本文中，我们报告了一例足月新生儿术后乳糜性腹水的病例。该婴儿在出生后第17天通过开胸手术进行心胸外科手术，以修复完全性肺静脉异位连接并伴有永存左上腔静脉，术后第12天（出生后第29天）腹围显著增加。腹部超声显示有8毫米厚的腹水，无胸腔积液。进行了腹腔穿刺，乳白色腹水苏丹III染色和乳糜试验呈阳性。腹水甘油三酯浓度为691毫克/分升，蛋白质浓度为39.4克/升。此外，腹水还含有6360×10/L的白细胞，以淋巴细胞为主。这些结果提示该婴儿出现了乳糜性腹水。采用禁食和基于中链甘油三酯的配方进行保守治疗成功解决了乳糜性腹水，且未复发。我们介绍了我们对这种罕见情况的经验，并讨论了该病例中乳糜性腹水的可能原因。
