Table of Contents
ISRN Hepatology
Volume 2014, Article ID 240473, 10 pages
Review Article

Chylous Ascites: Evaluation and Management

1Hepatology Unit, Department of Gastroenterology, Royal Victoria Hospital, McGill University Health Center, Montreal, QC, Canada
2Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University, P.O. Box 35, 123 Muscat, Oman

Received 28 September 2013; Accepted 19 December 2013; Published 3 February 2014

Academic Editors: D. Morioka, O. Topcu, and M. Watanabe

Copyright © 2014 Said A. Al-Busafi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Chylous ascites refers to the accumulation of lipid-rich lymph in the peritoneal cavity due to disruption of the lymphatic system secondary to traumatic injury or obstruction. Worldwide, abdominal malignancy, cirrhosis, and tuberculosis are the commonest causes of CA in adults, the latter being most prevalent in developing countries, whereas congenital abnormalities of the lymphatic system and trauma are commonest in children. The presence of a milky, creamy appearing ascitic fluid with triglyceride content above 200 mg/dL is diagnostic, and, in the majority of cases, unless there is a strong suspicion of malignancy, further investigations are not required in patients with cirrhosis. If an underlying cause is identified, targeted therapy is possible, but most cases will be treated conservatively, with dietary support including high-protein and low-fat diets supplemented with medium-chain triglycerides, therapeutic paracentesis, total parenteral nutrition, and somatostatins. Rarely, resistant cases have been treated by transjugular intrahepatic portosystemic shunt, surgical exploration, or peritoneovenous shunt.