Ascites, which is accumulation of fluid in the abdominal cavity, normally consists of clear fluid. Chylous ascites, which has a milky appearance, is caused by blockage or rupture of lymph glands and vessels around the abdominal cavity, resulting in leakage of chyle into the abdominal cavity. Chylous ascites is a rare but life-threatening complication; however, incidences of this condition have increased in recent years. Various conditions may cause chylous ascites.
Cancer
Cancer is the most common cause of chylous ascites. Around 60 percent of cases of chyle leaks occur because of lymphoma, which is cancer of the lymph glands, according to Stacey McCray, Registered Dietician, in the May 2004 issue of "Practical Gastroenterology." Cancer of any type, however, may rupture or block the lymph glands.
Cirrhosis
Severe liver damage, known as cirrhosis, is the second most common cause of chylous ascites in western countries, according to lead author Qi Huang of Ninjang University. He made this claim in the "World Journal of Gastroenterology" in 2004. Chylous ascites is still rare, even in patients with cirrhosis, occurring in just 0.5 to 1 percent of patients with cirrhosis who have ascites, according to lead author Tony Almakdisi, M.D., in the September 2005 issue of "The Oncologist."
Abdominal Trauma
Surgery and accidents can cause abdominal trauma, which can lead to chylous ascites. Inadvertent or unintended injury to the abdominal lymph nodes causes chylous ascites in surgical patients. Those who have complex surgeries more often develop chylous ascites, according to Huang. Between 1 and 3 percent of patients undergoing liver transplant develop chylous ascites, which usually resolves spontaneously in these cases, reports Jurg Reichen, M.D., of the University of Bern, Switzerland. Postoperative chylous ascites can occur as early as a week after damage to the lymph vessels at the time of surgery, or it may develop months afterward. Dr. Almakdisi reports that later development of chylous ascites occurs when abdominal scar tissue constricts the lymph vessels. Battered child syndrome accounts for as much as 10 percent of chylous ascites cases in children, Dr. Almakdisi adds.
Infection and Inflammation
Chylous ascites can develop in people with infections, particularly tuberculosis, Dr. Reichen reports. Inflammatory disorders such as Whipple disease, sarcoidosis, acute or chronic pancreatitis and filariasis have also caused chylous ascites, according to Dr. Almakdisi.
References
- "Practical Gastroenterology"; When Chyle Leaks: Nutritional Management Options; Stacey McCray, RD; May 2004
- "The Oncologist"; Lymphomas and Chylous Ascites: Review of the Literature; Tony Almakdisi, M.D.; September 2005
- "World Journal of Gastroenterology"; Chylous ascites: Treated with total parenteral nutrition and somatostatin; Qi Huang, Nanjing University; 2004
- University of Bern; Chylous Ascites; Jurg Reichen, M.D.
