Abdomen agudo por ascitis quilosa secundaria a pancreatitis aguda: reporte de un caso

RESUMEN

La ascitis quilosa (AQ) es una entidad rara, y puede manifestarse como una reacción peritoneal llamada peritonitis quilosa aguda (PQA). Presentamos el caso de un varón de 26 años, con cuadro abdominal agudo, por lo que es intervenido quirúrgicamente, encontrándose líquido lechoso turbio, en cavidad abdominal, realizándose una apendicectomía profiláctica, aspiración y lavado de cavidad, con colocación de drenajes. El análisis de líquido mostró aumento de triglicéridos y amilasa, gram y cultivos negativos; y la tomografía reveló una pancreatitis aguda (Baltazar C), todo ello confirmando el diagnóstico de AQ secundaria a pancreatitis. Paciente cursa con una evolución favorable con hidratación, analgésicos y dieta vía oral a tolerancia. En la literatura se han descrito muy pocos casos de PQA, y su asociación con pancreatitis aguda es bastante inusual. Pudiendo simular un cuadro abdominal agudo quirúrgico, cuyo tratamiento consiste en la exploración quirúrgica con drenaje peritoneal, pudiendo o no, requerir apoyo nutricional.

ABSTRACT

Chylous ascites (CA) is a rare condition, and it can present as a peritoneal reaction named acute chylous peritonitis (ACP). We report the case of a 26-year old male who developed acute abdomen. He underwent surgery and turbid milky fluid was found in his abdominal cavity. A prophylactic appendectomy was performed, as well as aspiration and lavage of the abdominal cavity. Drainage tubes were placed. Studies of the fluid revealed increased triglyceride and amylase contents. Gram-staining and cultures were negative. A computed tomography scan revealed acute pancreatitis (Balthazar C), so a diagnosis of chylous ascites secondary to pancreatitis was confirmed. The patient did well, he received hydration, analgesics, and oral diet according to tolerance. Very few cases of ACP have been reported in the literature, and its association with acute pancreatitis is very unusual. This condition may resemble surgical acute abdomen, and its management includes surgical exploration with peritoneal drainage. Nutritional support may also be needed.