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Review article: the diagnostic approach and current management of chylous ascites

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Lizaola, B., Bonder, A., Trivedi, H. D., Tapper, E. B., Cardenas, A.·2017·Alimentary Pharmacology & Therapeutics
DOI 10.1111/apt.14284
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Abstract

Summary: Background: Chylous ascites is rare, accounting for less than 1% of cases. An appropriate and stepwise approach to its diagnosis and management is of key importance. Aim: To review the current diagnostic approach and management of chylous ascites. Methods: A literature search was conducted using PubMed using the key words ‘chylous’, ‘ascites’, ‘cirrhosis’, ‘pathophysiology’, ‘nutritional therapy’, ‘paracentesis”, “transjugular intrahepatic portosystemic shunt” and “TIPSS’. Only articles in English were included. Results: Chylous ascites is caused by the traumatic or obstructive disruption of the lymphatic system that leads to extravasation of thoracic or intestinal lymph into the abdominal space and the accumulation of a milky fluid rich in triglycerides. The most common causes are malignancy, cirrhosis and trauma after abdominal surgery. This condition can lead to chyle depletion, which results in nutritional, immunologic and metabolic deficiencies. An ascitic triglyceride concentration above 200 mg/dL is consistent with chylous ascites. Treatment is based on management of the underlying cause and nutritional support. Conclusions: Chylous ascites is mostly due to malignancy and cirrhosis in adults, and congenital lymphatic disorders in children. Treatment with nutritional optimization and management of the underlying etiology are the cornerstones of therapy. When conservative measures fail, other interventions such as octreotide/somatostatin analogues, surgical ligation, embolization and transjugular intrahepatic portosystemic shunt in patients with cirrhosis can be considered.

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  • 1000 mL chyle leakage may contain up to 30 g of protein.

    “1000 mL chyle leakage may contain up to 30 g of protein [128].”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [128]

    The Laboratory findings section reports a total protein concentration of 2.5–7.0 g/dL in chylous ascites, equivalent to 25–70 g per 1000 mL. This supports the possibility of 30 g in a litre, but not the stated upper limit of 30 g; the reported range extends to 70 g. (LLM, conf=0.88)

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  1. Cardenas A, Chopra S. Chylous ascites. Am J Gastroenterol. 2002;97:1896-1900.
  2. Doerr CH, Allen MS, Nichols FC III, Ryu JH. Etiology of chylothorax in 203 patients. Mayo Clin Proc. 2005;80:867-870.
  3. Steinemann DC, Dindo D, Clavien PA, Nocito A. Atraumatic chylous ascites: systematic review on symptoms and causes. J Am Coll Surg. 2011;212:899-905.e891-894.
  4. Press OW, Press NO, Kaufman SD. Evaluation and management of chylous ascites. Ann Intern Med. 1982;96:358-364.
  5. Al-Busafi SA, Ghali P, Deschenes M, Wong P. Chylous ascites: evalu- ation and management. ISRN Hepatol. 2014;2014:240473.
  6. Chakraborty S, Davis MJ, Muthuchamy M. Emerging trends in the pathophysiology of lymphatic contractile function. Semin Cell Dev Biol. 2015;38:55-66.
  7. Browse NL, Wilson NM, Russo F, al-Hassan H, Allen DR. Aetiology and treatment of chylous ascites. Br J Surg. 1992;79:1145-1150.
  8. Rector WG Jr. Spontaneous chylous ascites of cirrhosis. J Clin Gas- troenterol. 1984;6:369-372.
  9. Yau KK, Siu WT, Li MK. Chylous ascites in a patient with esophageal carcinoma. Clin Gastroenterol Hepatol. 2005;3:A33.
  10. Wagayama H, Tanaka T, Shimomura M, Ogura K, Shiraki K. Pancre- atic cancer with chylous ascites demonstrated by lymphoscintigra- phy: successful treatment with peritoneovenous shunting. Dig Dis Sci. 2002;47:1836-1838.
  11. Malagelada JR, Iber FL, Linscheer WG. Origin of fat in chylous ascites of patients with liver cirrhosis. Gastroenterology. 1974;67:878-886.
  12. Runyon BA, Hoefs JC, Morgan TR. Ascitic fluid analysis in malig- nancy-related ascites. Hepatology. 1988;8:1104-1109.
  13. Kikolski SG, Aryafar H, Rose SC, Roberts AC, Kinney TB. Transjugu- lar intrahepatic portosystemic shunt for treatment of cirrhosis- related chylothorax and chylous ascites: single-institution retrospec- tive experience. Cardiovasc Intervent Radiol. 2013;36:992-997.
  14. Tsauo J, Shin JH, Han K, et al. Transjugular intrahepatic portosys- temic shunt for the treatment of chylothorax and chylous ascites in cirrhosis: a case report and systematic review of the literature. J Vasc Interv Radiol. 2016;27:112-116.
  15. Romero S, Martin C, Hernandez L, et al. Chylothorax in cirrhosis of the liver: analysis of its frequency and clinical characteristics. Chest. 1998;114:154-159.
  16. Lin O, Scholes JV, Lustbader IJ. Chylous ascites resulting from Kaposi's sarcoma in an AIDS patient. Am J Gastroenterol. 1994;89:2252-2253.
  17. Foschi D, Rizzi A, Corsi F, Trabucchi E, Corbellino M. Chylous ascites secondary to B-cell non Hodgkin's lymphoma in a patient with the acquired immune deficiency syndrome (AIDS). Dig Liver Dis. 2008;40:481-482.
  18. Vignes S, Bellanger J. Primary intestinal lymphangiectasia (Wald- mann's disease). Orphanet J Rare Dis. 2008;3:5.
  19. Duhra PM, Quigley EM, Marsh MN. Chylous ascites, intestinal lym- phangiectasia and the 'yellow-nail' syndrome. Gut. 1985;26:1266- 1269.
  20. Cohen MM, Jr. Klippel-Trenaunay syndrome. Am J Med Genet. 2000;93:171-175.
  21. Scribner DR Jr, Lara-Torre E, Heineck RJ, Weiss PM. Klippel-Trenau- nay syndrome complicated by ascites and vaginal lymphatic drainage in adolescence: a case report. J Pediatr Adolesc Gynecol. 2012;25: e139-e141.
  22. Gupta N, Kabra M, Ramesh K, et al. A female with hemihypertro- phy and chylous ascites -Klippel-Trenaunay syndrome or Proteus syndrome: a diagnostic dilemma. Clin Dysmorphol. 2006;15:229- 231.
  23. Iwasa T, Tani A, Miyatani Y, et al. Lymphangioma of the ovary accompanied by chylous ascites. J Obstet Gynaecol Res. 2009;35:812-815.
  24. Abadoglu O, Osma E, Ucan ES, et al. Behcet's disease with pul- monary involvement, superior vena cava syndrome, chyloptysis and chylous ascites. Respir Med. 1996;90:429-431.
  25. Cogar BD, Groshong TD, Turpin BK, Guajardo JR. Chylothorax in Henoch-Schonlein purpura: a case report and review of the litera- ture. Pediatr Pulmonol. 2005;39:563-567.
  26. Hurst PA, Edwards JM. Chylous ascites and obstructive lym- phoedema of the small bowel following abdominal radiotherapy. Br J Surg. 1979;66:780-781.
  27. Manolitsas TP, Abdessalam S, Fowler JM. Chylous ascites following treatment for gynecologic malignancies. Gynecol Oncol. 2002;86:370-374.
  28. Gilkeson GS, Allen NB. Retroperitoneal fibrosis. A true connective tissue disease. Rheum Dis Clin North Am. 1996;22:23-38.
  29. Lee CK, Han JM, Lee KN, et al. Concurrent occurrence of chylotho- rax, chylous ascites, and protein-losing enteropathy in systemic lupus erythematosus. J Rheumatol. 2002;29:1330-1333.
  30. Chen GL, Yang DH, Hsu WH. Chylous ascites and pleural transu- date: rare presentations in systemic lupus erythematosus in old age. Case Reports Immunol. 2012;2012:390831.
  31. Manzella DJ, Dettori PN, Hertimian ML, Melero MJ. Chylous ascites and chylothorax as presentation of a systemic progression of discoid lupus. J Clin Rheumatol. 2013;19:87-89.
  32. Cappell MS, Friedman D, Mikhail N. Chyloperitoneum associated with chronic severe sarcoidosis. Am J Gastroenterol. 1993;88:99-101.
  33. Provenza JM, Bacon BR. Chylous ascites due to sarcoidosis. Am J Gastroenterol. 1991;86:92-95.
  34. Maurer CA, Wildi S, Muller MF, Baer HU, Buchler MW. Blunt abdominal trauma causing chyloretroperitoneum. J Trauma. 1997;43:696-697.
  35. Beal AL, Gormley CM, Gordon DL, Ellis CM. Chylous ascites: a mani- festation of blunt abdominal trauma in an infant. J Pediatr Surg. 1998;33:650-652.
  36. Benhaim P, Strear C, Knudson M, Neal C, Coulter K, Villarreal S. Posttraumatic chylous ascites in a child: recognition and manage- ment of an unusual condition. J Trauma. 1995;39:1175-1177.
  37. Mukerji AN, Tseng E, Karachristos A, Maloo M, Jain A. Chylous ascites after liver transplant: case report and review of literature. Exp Clin Transplant. 2013;11:367-374.
  38. Williams AM, Seay TM, Hundley JC, Gedaly R. Direct intranodal lym- phangiography for recurrent chylous ascites following liver-kidney transplantation. Liver Transpl. 2014;20:1275-1276.
  39. Chen JH, Chang CM, Lu MC, Wei CK, Yin WY. Delayed-onset chy- lous ascites after a living-donor liver transplant: first case success- fully treated with conservative treatment. Exp Clin Transplant. 2016;14:345-348.
  40. Yilmaz M, Akbulut S, Isik B, et al. Chylous ascites after liver trans- plantation: incidence and risk factors. Liver Transpl. 2012;18:1046- 1052.
  41. Muela Molinero A, Borrego Galan JC, Quiroga Prado L. Chylous ascites secondary to Whipple disease. Rev Clin Esp. 2011;211:e28- e29.
  42. Kaufmann HJ. Chylous ascites and intestinal muscular hypertrophy occurring in the course of celiac sprue. Am J Dig Dis. 1975;20:494- 497.
  43. Yang AL, Baron TH, Hart PA. An uncommon cause of peripancreatic fluid. Gastroenterology. 2015;149:e3-e4.
  44. Lin WY, Lin GM, Wu CC. Coexistence of non-communicated chy- lothorax and chylous ascites in nephrotic syndrome. Nephrology. 2009;14:700.
  45. Villena V, de Pablo A, Martin-Escribano P. Chylothorax and chylous ascites due to heart failure. Eur Respir J. 1995;8:1235-1236.
  46. Riza Altiparmak M, Avsar S, Yanik S. Chylous ascites and chylothorax due to constrictive pericarditis in a patient undergoing haemodialy- sis. Neth J Med. 2004;62:59-61.
  47. Hurley MK, Emiliani VJ, Comer GM, Patel A, Navarro C, Maiki CO. Dilated cardiomyopathy associated with chylous ascites. Am J Gas- troenterol. 1989;84:1567-1569.
  48. Chen JY, Li WT, Hsu CH, et al. Chylous ascites and chylothorax: an unusual manifestation of cardiac amyloidosis. Intern Med. 2010;49:1763-1766.
  49. Andraus W, Nacif LS, Araujo RL, Buscariolli Ydos S, Salvato M, D'Albuquerque LA. Chronic pancreatitis associated with chylous ascites simulating liver cirrhosis. Case Rep Surg. 2013;2013:763561.
  50. Santos MA, Bose PS, Maher S, Desai M. Chylous ascites: an unusual complication of necrotizing pancreatitis. Am J Med. 2017;130:e151- e152.
  51. Gokturk HS, Demir M, Ozturk NA, et al. The role of ascitic fluid vis- cosity in the differential diagnosis of ascites. Can J Gastroenterol. 2010;24:255-259.
  52. Runyon BA. Care of patients with ascites. N Engl J Med. 1994;330:337-342.
  53. Tao L, Ning HJ, Nie HM, Guo XY, Qin SY, Jiang HX. Diagnostic value of adenosine deaminase in ascites for tuberculosis ascites: a meta-analysis. Diagn Microbiol Infect Dis. 2014;79:102-107.
  54. Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchison JG. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Intern Med. 1992;117:215-220.
  55. Khandwalla HE, Fasakin Y, El-Serag HB. The utility of evaluating low serum albumin gradient ascites in patients with cirrhosis. Am J Gas- troenterol. 2009;104:1401-1405.
  56. Uriz J, Cardenas A, Arroyo V. Pathophysiology, diagnosis and treat- ment of ascites in cirrhosis. Baillieres Best Pract Res Clin Gastroen- terol. 2000;14:927-943.
  57. Kumar KS, Lee WM. Chylous ascites with marked elevation of CA- 125 in cirrhosis. Am J Gastroenterol. 2000;95:3313-3314.
  58. Pui MH, Yueh TC. Lymphoscintigraphy in chyluria, chyloperitoneum and chylothorax. J Nucl Med. 1998;39:1292-1296.
  59. Noel AA, Gloviczki P, Bender CE, Whitley D, Stanson AW, Deschamps C. Treatment of symptomatic primary chylous disorders. J Vasc Surg. 2001;34:785-791.
  60. Patten RM, Calkins CM, Moore EE. Isolated traumatic rupture of the cisterna chyli: CT diagnosis. J Comput Assist Tomogr. 1999;23:701-702.
  61. Leibovitch I, Mor Y, Golomb J, Ramon J. The diagnosis and man- agement of postoperative chylous ascites. J Urol. 2002;167:449- 457.
  62. Weinstein LD, Scanlon GT, Hersh T. Chylous ascites. Management with medium-chain triglycerides and exacerbation by lymphangiogra- phy. Am J Dig Dis. 1969;14:500-509.
  63. Chen J, Lin RK, Hassanein T. Use of orlistat (xenical) to treat chylous ascites. J Clin Gastroenterol. 2005;39:831-833.
  64. Ilhan E, Demir U, Alemdar A, Ureyen O, Eryavuz Y, Mihmanli M. Management of high-output chylous ascites after D2-lymphadenect- omy in patients with gastric cancer: a multi-center study. J Gastroin- test Oncol. 2016;7:420-425.
  65. Berzigotti A, Magalotti D, Cocci C, Angeloni L, Pironi L, Zoli M. Octreotide in the outpatient therapy of cirrhotic chylous ascites: a case report. Dig Liver Dis. 2006;38:138-142.
  66. Zhou DX, Zhou HB, Wang Q, Zou SS, Wang H, Hu HP. The effec- tiveness of the treatment of octreotide on chylous ascites after liver cirrhosis. Dig Dis Sci. 2009;54:1783-1788.
  67. Leong RW, House AK, Jeffrey GP. Chylous ascites caused by portal vein thrombosis treated with octreotide. J Gastroenterol Hepatol. 2003;18:1211-1213.
  68. Weniger M, D'Haese JG, Angele MK, Kleespies A, Werner J, Hartwig W. Treatment options for chylous ascites after major abdominal sur- gery: a systematic review. Am J Surg. 2016;211:206-213.
  69. Pan W, Cai SY, Luo HL, et al. The application of nutrition support in conservative treatment of chylous ascites after abdominal surgery. Ther Clin Risk Manag. 2016;12:607-612.
  70. Aalami OO, Allen DB, Organ CH Jr. Chylous ascites: a collective review. Surgery. 2000;128:761-778.
  71. Kinney TB, Ferrara SL, Miller FJ, Roberts AC, Hassanein T. Tran- sjugular intrahepatic portosystemic shunt creation as treatment for refractory chylous ascites and chylothorax in a patient with cirrhosis. J Vasc Interv Radiol. 2004;15:85-89.
  72. McGrath EE, Blades Z, Anderson PB. Chylothorax: aetiology, diagno- sis and therapeutic options. Respir Med. 2010;104:1-8.
  73. Pamarthi V, Stecker MS, Schenker MP, et al. Thoracic duct emboliza- tion and disruption for treatment of chylous effusions: experience with 105 patients. J Vasc Interv Radiol. 2014;25:1398-1404.
  74. Kong TW, Chang SJ, Kim J, et al. Risk factor analysis for massive lymphatic ascites after laparoscopic retroperitonal lymphadenectomy in gynecologic cancers and treatment using intranodal lymphangiog- raphy with glue embolization. J Gynecol Oncol. 2016;27:e44.
  75. Yarmohammadi H, Brody LA, Erinjeri JP, et al. Therapeutic applica- tion of percutaneous peritoneovenous (denver) shunt in treating chylous ascites in cancer patients. J Vasc Interv Radiol. 2016;27:665- 673. How to cite this article: Lizaola B, Bonder A, Trivedi HD, Tapper EB, Cardenas A. Review article: the diagnostic approach and current management of chylous ascites. Aliment Pharmacol Ther. 2017;46:816-824. https://doi.org/10.1111/apt.14284

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Authors
Lizaola, B., Bonder, A., Trivedi, H. D., Tapper, E. B., & Cardenas, A.
Affiliations
  • St. Elizabeth's Medical Center (US)
  • Beth Israel Deaconess Medical Center (US)
  • University of Michigan (US)
  • GI/Liver Unit Institute of Digestive Diseases and Metabolism University of Barcelona Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi‐Sunyer (IDIBAPS) Barcelona Spain
ORCID
Venue
Alimentary Pharmacology & Therapeutics
Publisher
Wiley
Published
2017-09-11
Volume
46
Issue
9
Pages
816-824
ISSN
  • 0269-2813 (ISSN-L)
  • 1365-2036
DOI
10.1111/apt.14284
OpenAlex
W2754681424
Cited by
163
References
0
Citations by year
2026: 16 · 2025: 21 · 2024: 21 · 2023: 26 · 2022: 19 · 2021: 23 · 2020: 14 · 2019: 12 · 2018: 11
FWCI
2.14
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Alimentary Pharmacology & Therapeutics (publishedVersion)
  • PubMed (publishedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Lymphatic Disorders and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
Keywords
chylous ascites, lymphatic leakage, liver cirrhosis, cancer, nutritional support, transjugular intrahepatic portosystemic shunt, somatostatin analogues
MeSH terms
Chylous Ascites, Humans, Liver Cirrhosis, Lymphatic Diseases, Neoplasms, Wounds and Injuries

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