Huang C H, Chen H S, Chen Y M, Tsai T J
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Republic of China.
Nephron. 1996;72(4):708-11. doi: 10.1159/000188969.
Chyloperitoneum is a rare condition in patients undergoing peritoneal dialysis. We report here a patient who developed chylous ascites during the course of tuberculous peritonitis. The diagnosis was confirmed by cultures of dialysate and peritoneal biopsy, and laparoscopy revealed severe hyperemia and intestine adhesion. Intrinsic lymphatic obstruction and superimposed peritoneal fibrosis together might be responsible for the pathogenesis of this special presentation. Although in most cases of continuous ambulatory peritoneal dialysis, the causes of chyloperitoneum remained unknown, we suggest, from the experience of this case, that tuberculous peritonitis, especially the fibroadhesive form, should be highly suspected in any dialysis cases with chyloperitoneum. Laparoscopy should be initiated early, particularly when the culture is negative for common pathogens or when the patient responds poorly to the usual antimicrobial agents.
乳糜性腹水在接受腹膜透析的患者中是一种罕见的病症。我们在此报告一名在结核性腹膜炎病程中出现乳糜性腹水的患者。通过透析液培养和腹膜活检确诊，腹腔镜检查显示严重充血和肠粘连。内在的淋巴管阻塞和叠加的腹膜纤维化可能共同导致了这种特殊表现的发病机制。尽管在大多数持续性非卧床腹膜透析病例中，乳糜性腹水的病因仍不明，但根据本病例的经验，我们建议，对于任何出现乳糜性腹水的透析病例，应高度怀疑结核性腹膜炎，尤其是纤维粘连型。应尽早进行腹腔镜检查，特别是当常见病原体培养阴性或患者对常用抗菌药物反应不佳时。
