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Chylous Ascites Secondary to Pancreatitis: Management of an Uncommon Entity Using Parenteral Nutrition and Octreotide

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Abstract

Malignancy, surgical trauma, cirrhosis and tuberculosis account for more than 95% of causes for chylous ascites. We report a case of persistent chylous ascites following acute pancreatitis that responded to parenteral nutrition and octreotide. A 50 year-old male was diagnosed with acute alcoholic pancreatitis after presenting with typical abdominal pain, and elevated amylase and lipase. The acute symptoms resolved within one week. Four weeks later he started developing increased abdominal girth. Examination revealed the presence of shifting dullness and paracentesis confirmed diagnosis of chylous ascites. Investigations for the common causes of chylous ascites were negative. Laparoscopy confirmed the presence of fat necrosis within mesenteric lymph nodes linking the chylous ascites to the episode of pancreatitis. The Chylous ascites was resistant to the usual medical therapy, but responded only to the combination of octreotide and total parenteral nutrition with complete resolution of ascites in 8 weeks. This case of chylous ascites secondary to pancreatitis represents an uncommon presentation with effective management resulting in a dramatic response.

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Author notes

  1. Mohammed Y. Al-Ghamdi MD

    Present address: King Fahd Military Medical Complex, Dhahran, Saudi Arabia

  2. Anil Bedi MD

    Present address: Division of Gastroenterology—Therapeutic Endoscopy, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Authors and Affiliations

  1. Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia, Canada

    Mohammed Y. Al-Ghamdi MD, Anil Bedi MD, Ronald T. Tanton MD & Kevork M. Peltekian MD

  2. Memorial University, St. John’s, Newfoundland and Labrador, Labrador, Newfoundland, Canada

    S. Bharati Reddy MD

  3. Hepatology Services, 1278 Tower Road, VG Site, Halifax, Nova Scotia, Canada

    Kevork M. Peltekian MD

Authors
  1. Mohammed Y. Al-Ghamdi MD
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  2. Anil Bedi MD
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  3. S. Bharati Reddy MD
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  4. Ronald T. Tanton MD
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  5. Kevork M. Peltekian MD
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Corresponding author

Correspondence to Kevork M. Peltekian MD.

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Al-Ghamdi, M.Y., Bedi, A., Reddy, S.B. et al. Chylous Ascites Secondary to Pancreatitis: Management of an Uncommon Entity Using Parenteral Nutrition and Octreotide. Dig Dis Sci 52, 2261–2264 (2007). https://doi.org/10.1007/s10620-006-9734-8

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  • DOI: https://doi.org/10.1007/s10620-006-9734-8

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