Chylous ascites in children possibilities for conservative treatment

The accumulation of chylous fluid in the abdominal cavity is designated as chylous ascites or chyloperitoneum. The accumulated fluid has a milky appearance due to its high fat content. The chylous ascites can be congenital or acquired, primary or secondary. General therapeutic measures comprise adequate hydration, the correction of any disturbance of the acid-base balance, the replacement of plasma proteins, particularly plasma albumin. Most important is the limitation of fat intake and its replacement by medium chain triglycerides, which are reabsorbed directly into the portal circulation, thus decreasing the necessity for the production of large amounts of lymph in the intestine. In some cases however, long-term parenteral nutrition cannot be avoided. The prognosis of chylous ascites depends mostly on its cause, but a complete recovery is in principle possible and achievable. In cases where repeated paracentesis with evacuation of the fluid and dietary measures do not reduce the formation of chylous ascites, laparatomy should be performed with the aim of locating and surgically closing of the lymphoperitoneal fistula. If no fistula can be found the most affected segment of the bowel should be resected and any retroperitoneal leakage controlled. A two month old male infant with primary chylous ascites is reported who was successfully treated with skimmed milk and a medium chain triglyceride formula.