Chylous Ascites Secondary to Pancreatitis: Management
of an Uncommon Entity Using Parenteral Nutrition and Octreotide |
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Authors: | Mohammed Y Al-Ghamdi Anil Bedi S Bharati Reddy Ronald T Tanton Kevork M Peltekian |
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Institution: | (1) Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia, Canada;(2) Memorial University, St. John’s, Newfoundland and Labrador, Labrador, Newfoundland, Canada;(3) Hepatology Services, 1278 Tower Road, VG Site, Halifax, Nova Scotia, Canada;(4) Present address: King Fahd Military Medical Complex, Dhahran, Saudi Arabia;(5) Present address: Division of Gastroenterology—Therapeutic Endoscopy, University of Saskatchewan, Saskatoon, Saskatchewan, Canada |
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Abstract: | Malignancy, surgical trauma, cirrhosis and tuberculosis account
for more than 95% of causes for chylous ascites. We report a
case of persistent chylous ascites following acute pancreatitis that
responded to parenteral nutrition and octreotide. A 50 year-old male
was diagnosed with acute alcoholic pancreatitis after presenting with
typical abdominal pain, and elevated amylase and lipase. The acute
symptoms resolved within one week. Four weeks later he started
developing increased abdominal girth. Examination revealed the
presence of shifting dullness and paracentesis confirmed diagnosis of
chylous ascites. Investigations for the common causes of chylous
ascites were negative. Laparoscopy confirmed the presence of fat
necrosis within mesenteric lymph nodes linking the chylous ascites to
the episode of pancreatitis. The Chylous ascites was resistant to the
usual medical therapy, but responded only to the combination of
octreotide and total parenteral nutrition with complete resolution of
ascites in 8 weeks. This case of chylous ascites secondary to
pancreatitis represents an uncommon presentation with effective
management resulting in a dramatic response. |
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Keywords: | Acute pancreatitis Chylous ascites Alcohol Parenteral nutrition Octreotide |
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