Chylous ascites refers to a leakage of a natural bodily fluid called chyle into the abdominal cavity from a duct in the lymphatic system. It is a rare condition that can be caused by many different factors. Blunt trauma to the abdomen, cancer, liver cirrhosis, and surgical procedures can all lead to this condition. Without treatment, a person can experience severe abdominal pain, nausea, and fever. Treatment measures are targeted at finding and fixing the underlying cause in enough time to prevent serious complications.
Chyle is a thick, white substance comprised mainly of triglycerides and other fatty deposits absorbed by the small intestine. The substance travels through small lymphatic vessels to the main thoracic duct, where it can then drain and feed throughout the body. An obstruction in the thoracic duct, lymph node, or another element of the lymphatic system can cause a rupture that leaks chyle into the open spaces in the abdomen.
The most common causes of chylous ascites are primary or secondary cancers of the lymph nodes. Tumors obstruct lymph ducts, cause irritation, and eventually lead to ruptures. Chronic inflammatory conditions such as tuberculosis and cirrhosis can also lead to lymphatic complications, as can severe, direct injury to the abdomen. When the condition is present in children, congenital defects of the thoracic duct are usually found. Occasionally, chylous ascites is an accidental consequence of surgery to correct an abdominal hernia or remove a cancerous lymph node.
The first signs of chylous ascites usually include slight distention of the abdomen and feelings of nausea. A person might feel like he or she has a bad stomach ache, which can cause a loss of appetite. Fever, fatigue, and weakness are common as chyle continues to accumulate. Additional symptoms such as jaundice, joint aches, anemia, and head pain may be present as well, depending on the underlying cause.
Doctors can usually diagnose this condition by evaluating physical symptoms and taking diagnostic imaging scans of the abdomen. To confirm the diagnosis, a thin, hollow needle is inserted into the cavity to draw a sample of fluid. Ascites is evaluated in a hospital lab to make sure that it is indeed chyle buildup.
Treatment for chylous ascites typically involves starting a low-fat diet and using diuretics to help flush the body. A patient who experiences severe symptoms may need to be hospitalized so that a shunt can be placed in the abdomen to draw out excess chyle. If a tumor is discovered, it may need to be removed surgically to stop chyle leakage. Most patients are able to recover quickly from chylous ascites, but ongoing treatments and monitoring are usually needed to combat underlying chronic health problems.
