Congenital chylous ascites presenting with bilateral inguinal hernia and umbilical hernia: A case report

Chylous ascites refers to the leakage of lipid rich milky fluid into the peritoneal cavity. This usually occurs following trauma or obstruction of the lymphatic system. Moreover, an existing clear ascitic fluid can turn chylous as a secondary event. Milky appearance on gross appearance along with high fat (triglyceride) content usually suggestive of the diagnosis. We are reporting a 3 months infant with chylous ascites diagnosed during bilateral inguinal herniotomy. The patient presented bilateral scrotal with umbilical swelling for last one month. Examination showed bilateral inguinal hernia, umbilical hernia with mild abdominal distension. Bilateral herniotomy and subsequent ultrasound guided paracentesis revealed milky peritoneal fluid. Biochemical analysis revealed plenty of lymphocytes, high triglyceride content with increased cellularity and no abnormal cells suggestive of chylous ascites. Lymphoscintigraphy revealed leak from retroperitoneal lymphatics. Child improved following dietary modification and octreotide therapy without any surgical intervention. The aim of this case report is to describe the unusual presentation, it’s clinical and biochemical factors and role of conservative treatment of a patient with congenital chylous ascites.