Chen Zong-Qiang, Zeng Shu-Jun, Xu Chun
Department of Gastroenterology, Guangdong Medical University, Zhanjiang 524000, Guangdong Province, China.
Department of Gastroenterology, Huizhou Central People's Hospital, Huizhou 516000, Guangdong Province, China.
World J Hepatol. 2025 Jan 27;17(1):100797. doi: 10.4254/wjh.v17.i1.100797.
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.
乳糜性腹水是一种罕见病症，在腹水病例中发生率不到1%。它是由淋巴系统的创伤性或阻塞性破坏引起的，导致胸腔或肠道淋巴液漏入腹腔。这会导致富含甘油三酯的乳状液体积聚。在成年人中，恶性肿瘤和肝硬化是乳糜性腹水的主要病因。值得注意的是，乳糜性腹水仅占所有肝硬化相关腹水病例的0.5%至1%。目前，对这种病症的了解有限，在临床实践中进行有效的及时管理仍然具有挑战性。
本病例报告介绍了一名肝硬化合并乳糜性腹水的患者，该患者因腹胀多次住院。入院后，进行了全面的检查和评估。治疗策略的重点是通过低钠、低脂和高蛋白饮食补充中链甘油三酯来优化营养、进行治疗性腹腔穿刺放液和使用利尿剂。经过多学科讨论并对患者病情进行全面评估后，确认了手术指征。在告知患者益处和风险并获得同意后，进行了经颈静脉肝内门体分流术，成功缓解了腹部肿胀症状。本文详细介绍了这一罕见病例的临床特征和治疗方法，总结了肝硬化合并乳糜性腹水的当前管理方法。目的是为遇到类似情况的临床医生提供有价值的见解。
优化营养和解决根本原因在乳糜性腹水的治疗中至关重要。当保守方法证明无效时，可以考虑诸如经颈静脉肝内门体分流术等替代干预措施。
