Department of Medicine, Edward Via College of Osteopathic Medicine, Auburn, AL, USA.
Department of Medicine, Grandview Medical Center, Birmingham, AL, USA.
Am J Case Rep. 2024 Oct 7;25:e944609. doi: 10.12659/AJCR.944609.
BACKGROUND Chylous ascites is defined as the development of lipid-rich ascitic fluid in the peritoneal cavity. The formation of chylous ascites revolves around non-portal-based and portal-based etiologies, and the diagnosis is made via paracentesis revealing an elevated triglyceride level and milky-white appearance. Chylous ascites is often reported as a postoperative complication in surgical procedures, but it has also been documented in cases of cirrhosis, malignancy, and tuberculosis. However, chylous ascites is rarely seen in chronic pancreatitis and non-cirrhotic portal hypertension. This report presents the case of a 65-year-old man with a history of necrotizing pancreatitis and portal hypertension amidst an incidental finding of chylous ascites upon elective umbilical hernia repair. CASE REPORT We present the case of a patient with chylous ascites discovered during hernia repair. A 65-year-old man with no alcohol or tobacco use and a history of recurrent episodes of acute necrotizing pancreatitis was admitted for umbilical hernia repair. However, upon entering the abdominal cavity, an enlarging mass of ascitic fluid was encountered and tracked into the hernia sac. The fluid was drained via paracentesis and cytology revealed chylous ascites. The patient was discharged in stable condition and was advised to consume a high-protein, low-fat diet. Postoperative computed topography (CT) demonstrated an unchanged necrotic mass in the head of the pancreas. CONCLUSIONS This report demonstrates that when dealing with unexpected findings, it is important to consider the existence of multiple pathologies as the driving cause. We describe a complex cause of chylous ascites, along with a review of the literature on the relationship between chylous ascites and chronic pancreatitis.
乳糜性腹水是指腹腔内出现富含脂质的腹水。乳糜性腹水的形成围绕着非门脉和门脉为基础的病因，通过腹腔穿刺术发现甘油三酯水平升高和乳白色外观来做出诊断。乳糜性腹水常作为手术后并发症在外科手术中报告，但也有肝硬化、恶性肿瘤和结核病的病例记录。然而，在慢性胰腺炎和非肝硬化性门静脉高压症中，乳糜性腹水很少见。本报告介绍了一例 65 岁男性患者，有坏死性胰腺炎和门静脉高压病史，在择期脐疝修补术中偶然发现乳糜性腹水。
我们报告了一例在疝修补术中发现乳糜性腹水的患者。一位 65 岁的男性，没有饮酒或吸烟史，有反复发作的急性坏死性胰腺炎病史，因脐疝入院接受治疗。然而，当进入腹腔时，发现腹水增大的肿块，并追踪到疝囊内。通过腹腔穿刺术引流腹水，细胞学检查显示为乳糜性腹水。患者情况稳定出院，并建议患者食用高蛋白、低脂肪饮食。术后计算机断层扫描（CT）显示胰腺头部的坏死肿块没有变化。
本报告表明，在处理意外发现时，重要的是要考虑多种病理情况是潜在的驱动因素。我们描述了一例乳糜性腹水的复杂病因，并对乳糜性腹水与慢性胰腺炎之间的关系进行了文献复习。
