Caitlin Gribbin, MD1, Tracey Martin, MD1, David Wan, MD2
1New York-Presbyterian / Weill Cornell Medical Center, New York, NY; 2Weill Cornell Medical College, New York, NY
Introduction: Chylous ascites, or milky-appearing peritoneal fluid rich in triglycerides, is an uncommon finding that occurs in the presence of lymph in the abdominal cavity. The incidence has been reported as one in 20,000 hospital admissions though this number may be increasing due to improved survival in the setting of gastrointestinal malignancies. Etiology is most commonly associated with malignancy and other causes include cirrhosis, congenital malformations, traumatic causes as well as postoperative complications, and infectious or inflammatory diseases.
Case Description/Methods: A 52 year-old woman with a history of pancreatic cancer with metastases to the spine status-post C3-6 laminectomy and fusion as well as polycystic kidney disease (PCKD) status-post renal transplant presented with abdominal distension and fever. The patient underwent a paracentesis to rule-out spontaneous bacterial peritonitis (SBP) and was noted to have chylous ascites with a triglyceride level of 1323mg/dL in the ascites fluid. The patient remained hemodynamically stable and received treatment with piperacillin/tazobactam for presumed pneumonia versus urinary tract infection underlying the patient’s fever. Following rule-out of tuberculosis, the presence of chylous ascites was presumed to be secondary to tumor burden within the abdominal cavity and the patient was continued follow-up with oncology without further intervention from the gastrointestinal team.
Discussion: Chylous ascites is a rare finding associated with disruption of the lymphatic system in either the abdominal or thoracic cavity. It is most commonly associated with malignancy but can also be seen situations involving cirrhosis, trauma, postoperative complications, or congenital malformations. Occasionally, chylous ascites may be seen in inflammatory or infectious diseases, which must be ruled out if suspected. Associated symptoms include abdominal pain and distention, weight gain, and dyspnea. The condition is typically not suspected prior to performing a paracentesis, which is diagnostic. Treatment is aimed at correcting the underlying cause as well as addition of a low-fat, high-protein diet and therapeutic paracentesis as needed. In this case, the patient continued treatment with oncology alongside palliative measures to alleviate associated symptoms.
Citation: Caitlin Gribbin, MD; Tracey Martin, MD; David Wan, MD. P0072 - CHYLOUS ASCITES IN THE SETTING OF METASTATIC PANCREATIC CANCER: A CASE REPORT. Program No. P0072. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.