Chylous ascites secondary to pancreatitis: Management of an uncommon entity using parenteral nutrition and octreotide
Chylous ascites secondary to pancreatitis: Management of an uncommon entity using parenteral nutrition and octreotide
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DOI：
10.1007/s10620-006-9734-8
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发表时间：
2007-09-01
影响因子：
3.1
通讯作者：
Peltekian, Kevork M.
中科院分区：
文献类型：
--
作者：
Al-Ghamdi, Mohammed Y.;Bedi, Anil;Peltekian, Kevork M.
乳糜性腹水的病因中，结核病、手术创伤、肝硬化和肺结核占95%以上。我们报告一例急性胰腺炎后持续性乳糜腹水，对肠外营养和奥曲肽有反应。一名50岁男性在出现典型腹痛、淀粉酶和脂肪酶升高后被诊断为急性酒精性胰腺炎。急性症状在一周内消退。四周后，他开始出现腹围增加。检查发现存在移动性浊音和穿刺确诊乳糜腹水。乳糜性腹水常见病因的调查结果均为阴性。腹腔镜检查证实肠系膜淋巴结内存在脂肪坏死，将乳糜性腹水与胰腺炎发作联系起来。乳糜性腹水对常规药物治疗有抵抗力，但仅对奥曲肽和全肠外营养的联合治疗有反应，腹水在8周内完全消退。胰腺炎继发乳糜性腹水是一种少见的表现，经过有效的治疗后有显著的疗效。
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.