Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Monday, 07 / 23 / 2018

Articles

Chylous Ascites: A Review of Pathogenesis, Diagnosis and Treatment

REVIEW ARTICLE

Chylous Ascites: A Review of Pathogenesis, Diagnosis and Treatment

Richa Bhardwaj*,1, Haleh Vaziri1, Arun Gautam1, Enrique Ballesteros2, David Karimeddini3 and George Y. Wu1

1Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT, USA
2Department of Pathology and Lab Medicine, UCONN Health, Farmington, CT, USA
3Department of Diagnostic Imaging and Therapeutics, UCONN Health, Farmington, CT, USA

*Correspondence to: Richa Bhardwaj, Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT 06030, USA. Tel/Fax: +1-860-679-4613, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2018;6(1):105-113 DOI: 10.14218/JCTH.2017.00035
Received: May 27, 2017 Accepted: September 30, 2017 Published online: December 4, 2017

Abstract

Chylous ascites (CA) is a rare form of ascites that results from the leakage of lipid-rich lymph into the peritoneal cavity. This usually occurs due to trauma and rupture of the lymphatics or increased peritoneal lymphatic pressure secondary to obstruction. The underlying etiologies for CA have been classified as traumatic, congenital, infectious, neoplastic, postoperative, cirrhotic or cardiogenic. Since malignancy and cirrhosis account for about two-thirds of all the cases of CA in Western countries, in this article we have attempted to reclassify CA based on portal and non-portal etiologies. The diagnosis of CA is based on the distinct characteristic of the ascitic fluid which includes a milky appearance and a triglyceride level of >200 mg/dL. The management consists of identifying and treating the underlying disease process, dietary modification, and diuretics. Some studies have also supported the use of agents such as orlistat, somatostatin, octreotide and etilefrine. Paracentesis and surgical interventions in the form of transjugular intrahepatic portosystemic shunt (commonly known as TIPS), peritoneal shunt, angiography with embolization of a leaking vessel, and laparotomy remain as treatment options for cases refractory to medical management.

Keywords

Chylous ascites, Portal hypertension, Cirrhosis, Ascitic fluid, Lymphatic system

 

 

Journal of Clinical and Translational Hepatology 2018 vol. 6, 105-113  [ Html ] [ PDF Full-text ]

© The Authors 2018. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

 

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