Acute chylous ascites mimicking acute appendicitis in a patient with pancreatitis

Table 1 Aetiology of chylous ascites[3]

Congenital (most common in the paediatric population)

Congenital idiopathic

Intestinal lymphangiectasia (mega lymphatics)

Primary lymphatic hypoplasia

Chyle cysts

Lymphangiomatosis

Acquired

Neoplastic (most common in adult population)

Malignant

Lymphoma

Kaposi’s sarcoma

Lymphangiomyomatosis

Carcinoid tumours

Other cancers (breast, pancreatic, colon, renal, testicular, ovarian, prostate)

Benign

Postoperative

Resection of the abdominal aorta

Retroperitoneal lymphadenectomy

Pancreaticoduodenectomy

Vagotomy

Radical nephrectomy

Warren shunt

Nissen fundoplication

Placement of peritoneal dialysis catheter

IVC resection

Inflammatory

Radiation therapy

Tuberculosis

Pancreatitis

Filariasis/ascariasis

Peritoneal dialysis

Sarcoidosis

Constrictive pericarditis

Retroperitoneal fibrosis

Coeliac spurae

Whipple’s disease

Retractile mesenteritis

Traumatic

Blunt (including Battered Child Syndrome)

Shear force to the root of the mesentery

Penetrating

Obstructive

Adhesions

Volvulus

Intussusception

Aortic aneurysm

Haemodynamic

Cirrhosis

Right heart failure

Dilated cardiomyopathy

Jugular, innominate, left subclavian, or portal vein thrombosis

Nephrotic syndrome

Table 2 Characteristics of ascitic fluid in chylous ascites[1]

Colour	Milky and cloudy
Triglyceride level	Above 200 mg/dL (2.28 mmol/L)
Cell count	Above 500 (predominance of lymphocytes)
SAAG	Below 1.1 g/dL
Cholesterol	Low (ascites:serum < 1)
LDH	Between 110-200 IU/L
Culture	Positive in some cases of tuberculosis
Amylase	Elevated in cases of pancreatitis
Glucose	Under 100 mg/dL
Cytology	Positive in some cases of malignancy