Refractory congenital chylous ascites: First report of fibrin glue and mesh application by laparoscopy.

Chylous ascites (CA) is a form of ascites having leakage of lipid-rich lymph into the peritoneal cavity, due to damage or obstruction in the lymphatic system. Aetiology of CA could be congenital or acquired. Primary lymphatic hypoplasia is seen commonly in children and presents with lymphoedema, chylothorax or CA. CA is initially treated conservatively with the aim to provide gut rest and decrease intestinal secretions. Surgical treatment is recommended if 1-2 months of conservative approach fails. The success of the operation depends on identifying the site of leakage of the lymphatic duct. Surgical options are ligation of leaking lymphatics, peritoneo-venous shunt, laparotomy and fibrin glue. Laparoscopy has been used for diagnosis but not for glue and mesh application in congenital CA where the lymphatic leak is unidentified. We present here the first experience of laparoscopic fibrin glue and mesh application in congenital CA with successful outcomes.

Refractory Congenital Chylous Ascites: Role of Fibrin Glue in its Management.

Chylous ascites is the accumulation of triglyceride-rich lymph in the abdomen. Its occurrence during the infantile period is quite rare. Congenital chylous ascites (CCA) is one, which occurs in children <3 months of age, due to maldevelopment of the lymphatic system. There is no clearly defined treatment protocol for CCA; however, the use of medium-chain triglycerides (MCT)-based diet or total parenteral nutrition (TPN) with octreotide has been successful. Failure of conservative management, however, leads to surgical exploration to deal with those leaking lymphatics. In our case, we had initially given a trial of managing the child with MCT-based diet followed by a TPN along with octreotide. However, the failure of both leads us to operate the child during which we incorporated the use of fibrin glue over the leaking mesenteric lymphatic vesicles, which ultimately led to the resolution of the chylous ascites.

Congenital chylous ascites treated successfully with MCT-Based formula and octreotide.

Medium chain triglyceride (MCT)-based diet, total parenteral nutrition (TPN) and repeated paracentesis are considered as supportive management for congenital chylous ascites (CCA). TPN is considered where therapy with oral MCT is poorly tolerated by the patient especially young infant with unstable hemodynamic. Surgery is recommended when medical therapy fails. Herein, we report a 2½-month-old infant with CCA, treated successfully with octreotide intravenous infusion after the initial failure to response to conventional conservative therapy with MCT-enriched formula and paracentesis.

Nano Carbon Tracer in the Repairing of Congenital Abdominal Chylorus Leakage.

Congenital chylous ascites (CCA) is a rare cause of ascites in newborn infants. The main causes include congenital lymphatic obstruction due to atresia or stenosis of the major lacteals, mesenteric cysts and lymphangiomatosis. The mainstay of treatment for CCA is conservative management including medium-chain triglycerides (MCT)-based diet or total parenteral nutrition (TPN), and the addition of octreotide. Surgical exploration is reserved for those cases in whom conservative management has failed. The core problem of chylous abdominal surgery is to find the leakage; once the exact chylous leakage is found, the problem will be solved. The authors used a new carbon nanopartides material to accurately locate the location of chylous leakage. The operation is simple and fast, easy to use, and the effect is remarkable.

Successful surgical treatment of congenital chylous ascites co-existed with congenital hypothyroidism: A rare case report.

INTRODUCTION AND IMPORTANCE: Chylous ascites is a rare condition in children wherein milky fluid accumulates in the abdomen. It is caused by various factors and presents with abdominal distension. Diagnosis involves imaging and fluid analysis obtained through paracentesis. Treatment options range from conservative measures to surgery. The association with congenital hypothyroidism is not well-established. CASE PRESENTATION: A 3-week-old male infant presented with abdominal distention. Diagnosis revealed congenital chylous ascites and congenital hypothyroidism. Initially, he was treated conservatively with medium-chain triglycerides and total parenteral nutrition, paracentesis, and thyroid hormone supplementation. The patient's condition worsened, necessitating octreotide therapy, blood transfusion, and antibiotics. The conservative treatment failed, and the patient underwent surgery; however, the exact source of fluid leakage could not be identified. Follow-up ultrasound examinations showed no ascitic fluid in the subsequent months. CLINICAL DISCUSSION: Congenital chylous ascites can be caused by congenital malformations or idiopathic factors. Symptoms include abdominal distension and respiratory difficulties. Diagnosis involves imaging and fluid analysis through paracentesis. To our knowledge, this represents the third case of congenital chylous ascites in the associated with congenital hypothyroidism described in the literature and the first one to be treated with surgery. CONCLUSION: Treatment options range from conservative measures such as diet management and paracentesis to somatostatin therapy. Surgery is considered in refractory cases. An association between congenital hypothyroidism and congenital chylous ascites has been reported in few cases.

Congenital Chylous Ascites: A Rare Cause of Infantile Ascites Treated With MCT-Based Diet and Octreotide.

Congenital chylous ascites (CCAs) are a rare disease that results from the accumulation of chylomicron-rich lymphatic fluid within the peritoneal cavity due to maldevelopment of the intra-abdominal lymphatic system. Medium-chain triglyceride (MCT)-based diet, total parenteral nutrition (TPN), and repeated paracentesis are considered supportive management for CCA. Cases unresponsive to conservative treatment usually require surgical intervention. We report a case of CCA in a premature neonate treated successfully with intravenous infusion of octreotide (synthetic somatostatin analog), after failing to respond to supportive therapies. Due to the lack of standards in diagnosis and treatment, this disease constitutes a medical challenge, and individual therapy seems to be noteworthy.

Midodrine, an Oral Alpha-1 Adrenoreceptor Agonist, Successfully Treated Refractory Congenital Chylous Pleural Effusion and Ascites in a Neonate.

A trisomy 21 neonate presented with congenital chylous pleural effusion and ascites that was refractory to conventional pharmacotherapy. Midodrine, an oral alpha-1-adrenoreceptor agonist, achieved remission of chylous effusion without any adverse effects. To the best of our knowledge, this is the first neonatal case of successful management of congenital chylous pleural effusion and ascites with midodrine.

Congenital chylous ascites.

Congenital chylous ascites is a rare entity, conditioned by numerous factors and with changing dynamics of the disease. Because of the lack of therapeutic and diagnostic standards, this disease constitutes to be a medical challenge. This article presents current knowledge on pathogenesis, diagnostics and management of this disease, as well as a case of a newborn with primary congenital chylous ascites in the abdominal cavity.