Xuan Hoi Nguyen, Thi Huyen Anh Nguyen, Thi Ly Phung, Dang Tuan Nguyen
National Hospital of Obstetrics and Gynecology, Hanoi, Vietnam.
Hanoi Medical University, Hanoi, Vietnam.
Ann Med Surg (Lond). 2025 Aug 8;87(9):6211-6215. doi: 10.1097/MS9.0000000000003686. eCollection 2025 Sep.
Chylous ascites is an exceptionally rare condition during pregnancy, typically presenting with nonspecific symptoms. To date, only a limited number of cases have been reported in the literature, and the majority of which occurred in singleton pregnancies.
We report the case of a 25-year-old woman with a twin pregnancy who was admitted at 32 weeks of gestation with acute abdominal pain and nausea. Due to persistent severe pain, unexplained intraperitoneal fluid, and progressing labor, an emergent cesarean section was performed. Intraoperatively, 2000 mL of milky white fluid was discovered in the peritoneal cavity. Biochemical analysis with markedly elevated triglycerides confirmed the diagnosis of chylous ascites. Postoperative management included broad-spectrum intravenous antibiotics, octreotide injection, and a low-fat diet supplemented with medium-chain triglyceride oil. By postoperative day 7, ultrasound showed complete resolution of ascites, and the patient was discharged in stable condition. No recurrence was noted during 3 years of follow-up.
This report presents a rare case of spontaneous chylous ascites in a previously healthy pregnant woman with a twin gestation. Potential mechanism for chylous ascites in our case can be due to enlarged gravid uterus of twin gestation during late pregnancy, which suppress the abdominal thoracic duct of mother and increase the pressure of the duct. Another possible mechanism involves the physiological effects of progesterone during pregnancy. Progesterone is known to induce smooth muscle relaxation, which can lead to dilation of lymphatic vessels and increased lymphatic flow. This vasodilatory effect may predispose to lymphatic leakage and contribute to the development of chylous ascites. The presence of milky white peritoneal fluid combined with a markedly elevated triglyceride concentration (≥ 110 mg/dL, 1945 mg/dL in our case) was key to confirm the diagnosis of chylous ascites. Treatment strategies typically depends on the underlying etiology and may include dietary modification (low-fat, MCT-enriched diet), pharmacologic therapy (somatostatin or octreotide), and surgical interventions in refractory cases.
Chylous ascites should be included in the differential diagnosis of unexplained ascites in twin gestation, particularly when the fluid exhibits a milky appearance. Although chylous ascites resolves spontaneously in the postpartum period, this condition may necessitate the termination of pregnancy and requires a multidisciplinary approach, involving obstetricians, gastrointestinal surgeons, radiologists, and nutritionists, for timely diagnosis and effective management.
乳糜性腹水在孕期极为罕见，通常表现为非特异性症状。迄今为止，文献中仅报道了少数病例，其中大多数发生在单胎妊娠中。
我们报告一例25岁双胎妊娠女性病例，该患者在妊娠32周时因急性腹痛和恶心入院。由于持续的剧烈疼痛、不明原因的腹腔积液以及产程进展，遂行急诊剖宫产。术中，在腹腔内发现2000毫升乳白色液体。甘油三酯显著升高的生化分析确诊为乳糜性腹水。术后管理包括广谱静脉抗生素、奥曲肽注射以及补充中链甘油三酯油的低脂饮食。术后第7天，超声显示腹水完全消退，患者病情稳定出院。随访3年未见复发。
本报告展示了一例先前健康的双胎妊娠孕妇发生自发性乳糜性腹水的罕见病例。本例乳糜性腹水的潜在机制可能是妊娠晚期双胎妊娠的增大子宫压迫母亲的腹腔胸导管并增加导管压力。另一种可能的机制涉及孕期孕酮的生理作用。已知孕酮可诱导平滑肌松弛，这可导致淋巴管扩张和淋巴液流量增加。这种血管舒张作用可能易引发淋巴渗漏并促使乳糜性腹水的形成。乳白色腹腔积液的存在以及甘油三酯浓度显著升高（≥110毫克/分升，本例为1945毫克/分升）是确诊乳糜性腹水的关键。治疗策略通常取决于潜在病因，可能包括饮食调整（低脂、富含中链甘油三酯的饮食）、药物治疗（生长抑素或奥曲肽）以及难治性病例的手术干预。
乳糜性腹水应纳入双胎妊娠不明原因腹水的鉴别诊断中，尤其是当液体呈现乳白色外观时。尽管乳糜性腹水在产后可自发消退，但这种情况可能需要终止妊娠，并且需要多学科方法，包括产科医生、胃肠外科医生、放射科医生和营养师，以实现及时诊断和有效管理。
