C A S E RE P O R T Milky Mesentery: Acute Abdomen with Chylous Ascites AAKANKSHA GOEL, MANISH KUMAR GAUR AND PANKAJ KUMAR GARG From Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India. Correspondence to: Dr Aakanksha Background: Clinical presentations of intestinal lymphangiectasia include pitting edema, Goel, House No 1 Sukh Vihar, chylous ascites, pleural effusion, diarrhea, malabsorption and intestinal obstruction. Case Delhi 110 051, India. Characteristics: An 8-year-old male child presented to the emergency department with
[email protected] clinical features of peritonitis, raising suspicion of appendicular or small bowel perforation. Intervention/Outcome: Diagnosis of chylous ascites with primary intestinal Received: July 21, 2017; lymphangiectasia made on laparotomy. Message: Acute peritonitis may be a presentation Initial Review: December 26, 2017; of primary intestinal lymphangiectasia and chylous ascites. Accepted: May 24, 2018. Keywords: Acute abdomen, Intestinal lymphangiectasia, Peritonitis. lthough lymphangiectasia is common in the (lymphangiectasia) was made. The chylous fluid was neck and axilla, it rarely involves intra- drained and a thorough peritoneal lavage was done. abdominal organs [1]. Intestinal Biopsies were taken from the mesenteric lymph nodes and Alymphangiectasia is characterized by peritoneum. dilatation of intestinal lymphatics [2,3]. The clinical Histopathological report was negative for tuberculosis presentations of intestinal lymphangiectasia include and malignancy. The ascitic fluid was rich in triglycerides pitting edema, chylous ascites, pleural effusion, diarrhea, (254 mg/dL) and demonstrated chylomicrons and malabsorption and intestinal obstruction. Acute lymphocytes on biochemical analysis. Culture and gram peritonitis is a rare presentation, and it may mimic other stain were negative.