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Congenital chylous ascites

Journal of Perinatology volume 29, pages 178–180 (2009)Cite this article

The initial paracentesis demonstrated fluid with 89% lymphocytes and numerous red blood cells. After the infant was placed on a fat-containing diet, the triglyceride level, which originally was low, in the ascitic fluid rose to 460 mg per 100 ml. Therefore, the diagnosis of congenital chylous ascites was made and the infant was kept on total parenteral nutrition for 12 days until the ascites had resorbed, and then was maintained on Portagen (medium chain triglyceride formula) for 2 months.

Isolated fetal and neonatal ascites (without hydrops) is infrequent and chylous ascites is an uncommon as a cause.1 The most common cause of isolated fetal ascites is urinary obstruction, particularly posterior urethral valves and less commonly urethral atresia.2, 3 Most of these cases are associated with oligohydramnios. Approximately 60 to 70% of cases of fetal ascites are due to urinary tract obstruction. Hepatobiliary and intestinal causes account for 15 to 30% of cases. The most common of these causes are hepatitis, biliary atresia, bowel perforation and meconium peritonitis. Chylous ascites makes up 4 to 20%3, 4 of cases of fetal and neonatal ascites. In the neonatal period, polycystic kidney disease and massive nephroblastomatosis can occasionally produce an appearance referred to as ‘roentgenographic pseudo ascites’ on a plain frontal radiograph of the abdomen.4 This is due to medial displacement of bowel loops by the massive enlarged retroperitoneal renal parenchyma, simulating ascites in these patients.5

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  1. Department of Radiology, Mallinckrodt Institute of Radiology, St Louis Children's Hospital, Washington University School of Medicine, St Louis, MO, USA

    T E Herman & M J Siegel

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  1. T E Herman
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  2. M J Siegel
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Correspondence to T E Herman.

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Herman, T., Siegel, M. Congenital chylous ascites. J Perinatol 29, 178–180 (2009). https://doi.org/10.1038/jp.2008.125

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