Chylous ascites: A review of pathogenesis, diagnosis and treatment

Richa Bhardwaj, Haleh Vaziri, Arun Gautam, Enrique Ballesteros, David Karimeddini, George Y. Wu

Research output: Contribution to journalReview articlepeer-review

124 Scopus citations

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 obstruc-tion. The underlying etiologies for CA have been classified as traumatic, congenital, infectious, neoplastic, postoperative, cirrhotic or cardiogenic. Since malignancy and cirrhosis ac-count 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. Para-centesis 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.

Original languageEnglish
Pages (from-to)105-113
Number of pages9
JournalJournal of Clinical and Translational Hepatology
Volume6
Issue number1
DOIs
StatePublished - 2018

Keywords

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

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