Refractory Chylous Ascites

A 34-year-old woman with primary chylous ascites due to lymphangiectasias was treated with sclerotherapy of dilated lymphatics and a lymphovenous shunt. She was referred to our institution after a thorough diagnostic and therapeutic approach in her community hospital. After four weeks of intensive diagnostic study, no secondary etiology for her chylous disorder was established. Conservative treatment did not prove useful, and a laparotomy was done. Lymphangiectasias and a lymphatic leak were demonstrated, but primary closure was ineffective. A second surgery with derivative intention was done, but six months later ascites recurred. A new sclerosing surgery was done; afterwards, the patient remained free of symptoms. Primary chyloperitoneum is a rare and complex disorder; its treatment and outcome depend on a multidisciplinary approach and an experienced medical team.