P0141 - Chylous Ascites Associated With Idiopathic Pancreatitis: A Rare Case Report

Patrick Tempera, DO, Maheep Sangha, MBBS, Robert Gianotti, MD
Albany Medical Center, Albany, NY

Introduction: Chylous ascites is a milky appearing peritoneal fluid that is rich in triglycerides and is due to the presence of thoracic or intestinal lymph in the abdominal cavity. It is an uncommon finding with an incidence of about 1 per 20,000 admissions. Malignancy, trauma, cirrhosis, and tuberculosis account for more than 95% of causes. We describe the case of chylous ascites secondary to acute idiopathic pancreatitis, a much less common etiology with only a small number of cases described in literature.

Case Description/Methods: We present the case of 56-year-old female with no past medical history who presented to the hospital for one day of abdominal pain and nausea. CT showed large amount of abdominal ascites. She underwent paracentesis with white-opaque fluid removed, seen in Image 1. Ascitic fluid and blood count data can be seen in Table 1. Microbiology data including TB did not show any infection. CEA, AFP, and CA 19-9 tumor markers were normal. MRCP showed no evidence of mass, cirrhosis, or bile duct obstruction. Abdominal ultrasound had no evidence of cholelithiasis or common bile duct dilation, 0.3mm. To assess lymphatic disruption, a lymphoscintigraphy was performed which showed no abnormal radiotracer activity to suggest lymphatic leakage into the peritoneal space. EUS showed pancreatic parenchymal abnormalities consistent with recent acute pancreatitis at the head and genu. A small amount of hyperechoic material consistent with sludge was visualized in the gallbladder. Ultimately, it was postulated that the patient had acute pancreatitis potentially due to gallbladder sludge, which was complicated by chylous ascites, likely from a lymphatic disruption near the pancreas. The patient made a full recovery with recommendations for cholecystectomy to prevent recurrence.

Discussion: In cases with disruption of normal lymphatic flow, the peritoneal cavity can fill with milky fluid rich in triglycerides. The most common causes within Western countries include abdominal malignancies and cirrhosis. It is important to differentiate chylous fluid from pus, pseudochyle, and ascites. Abdominal fluid with milky consistency and triglyceride level 2 to 8-fold greater than serum level was instrumental in helping our diagnosis. It has been postulated that lymph may leak through destroyed lymphatics due to pancreatic enzyme erosions or that chylous accumulation is the result of exudation of chyle caused by obstruction of lymphatic channel flow secondary to severe inflammatory changes surrounding the pancreas.




Disclosures:


Patrick Tempera, DO, Maheep Sangha, MBBS, Robert Gianotti, MD. P0141 - Chylous Ascites Associated With Idiopathic Pancreatitis: A Rare Case Report, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.