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Clinical Journal of Gastroenterology

, Volume 11, Issue 3, pp 235–239 | Cite as

Idiopathic chylous ascites in a patient with HIV infection: response to total parenteral nutrition and octreotide therapy

  • Gonçalo Nunes
  • Cristina Fonseca
  • Rita Barosa
  • Marta Patita
  • André Gomes
  • Júlio Botas
  • Hélder Coelho
  • Maria José Brito
  • Jorge Fonseca
Case Report

Abstract

The authors describe a 47-year-old man infected with human immunodeficiency virus admitted for ascites and weight loss. Ascitic fluid analysis revealed chylous ascites (triglycerides 444 mg/dl) with negative microbiological tests. Neoplasia, cardiac disease and liver cirrhosis were excluded after an extensive diagnostic workout. Exploratory laparotomy with tissue sampling did not clarify ascites etiology. During hospital admission, patient status gradually deteriorated, severe malnutrition developed and ascites became refractory to diuretics. Total parenteral nutrition and octreotide therapy were started and maintained for 3 weeks with ascites resolution and no relapse after oral diet resumption. Chylous ascites is a rare entity with several causes that compromise intra-abdominal lymphatic drainage. This case illustrates the difficulty in establishing etiology in some patients and the effectiveness of total parenteral nutrition plus octreotide therapy in idiopathic chylous ascites in HIV-infected patients.

Keywords

Chylous ascites Total parenteral nutrition Octreotide 

Notes

Acknowledgements

There are any acknowledgements regarding this manuscript.

Funding

There are no financial disclosures to report.

Compliance with ethical standards

Conflict of interest

There are any conflict of interest regarding this manuscript and its publication.

Human/animal rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients for being included in the study.

References

  1. 1.
    Al-Busafi SA, Ghali P, Deschênes M, et al. Chylous ascites: evaluation and management. ISRN Hepatol. 2014;2014:240473.  https://doi.org/10.1155/2014/240473 (eCollection 2014).CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Laterre PF, Dugernier T, Reynaert MS, et al. Chylous ascites: diagnosis, causes and treatment. Acta Gastroenterol Belg. 2000;63(3):260–3.PubMedGoogle Scholar
  3. 3.
    Kumar P, Chandra K. Chylous ascites due to tuberculosis: a case report and review of literature. Indian J Clin Pract. 2013;24(7):640–1.Google Scholar
  4. 4.
    Shaik Imam H, Gonzalez-Ibarra Fernando, Khan Rumana, et al. Chylous ascites in a patient with HIV/AIDS: a late complication of mycobacterium avium complex-immune reconstitution inflammatory syndrome. Case Rep Infect Dis. 2014;2014:268527.  https://doi.org/10.1155/2014/268527 (Epub 2014 Nov 18).PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Al-Ghamdi MY, Bedi A, Reddy SB, et al. Chylous ascites secondary to pancreatitis: management of an uncommon entity using parenteral nutrition and octreotide. Dig Dis Sci. 2007;52(9):2261–4.CrossRefPubMedGoogle Scholar
  6. 6.
    Shapiro AM, Bain VG, Sigalet DL, et al. Rapid resolution of chylous ascites after liver transplantation using somatostatin analog and total parenteral nutrition. Transplantation. 1996;61(9):1410–1.CrossRefPubMedGoogle Scholar
  7. 7.
    Yang C, Zhang J, Wang S, et al. Successful management of chylous ascites with total parenteral nutrition and octreotide in children. Nutr Hosp. 2013;28(6):2124–7.  https://doi.org/10.3305/nutrhosp.v28in06.6480.PubMedCrossRefGoogle Scholar
  8. 8.
    Berzigotti A, Magalotti D, Cocci C, et al. Octreotide in the outpatient therapy of cirrhotic chylous ascites: a case report. Dig Liver Dis. 2006;38(2):138–42.PubMedGoogle Scholar
  9. 9.
    Yildirim AE, Altun R, Can S, et al. Idiopathic chylous ascites treated with total parenteral nutrition and octreotide. A case report and review of the literature. Eur J Gastroenterol Hepatol. 2011;23(10):961–3.  https://doi.org/10.1097/MEG.0b013e328349aa2d.CrossRefPubMedGoogle Scholar
  10. 10.
    Lizaola B, Bonder A, Trivedi HD, et al. Review article: the diagnostic approach and current management of chylous ascites. Aliment Pharmacol Ther. 2017;46(9):816–24.  https://doi.org/10.1111/apt.14284.CrossRefPubMedGoogle Scholar
  11. 11.
    Unger SW, Chandler JG. Chylous ascites in infants and children. Surgery. 1983;93:455–61.PubMedGoogle Scholar
  12. 12.
    de Vries GJ, Ryan BM, de Bièvre M, et al. Cirrhosis related chylous ascites successfully treated with TIPS. Eur J Gastroenterol Hepatol. 2005;17(4):463–6.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  • Gonçalo Nunes
    • 1
  • Cristina Fonseca
    • 1
  • Rita Barosa
    • 1
  • Marta Patita
    • 1
  • André Gomes
    • 2
  • Júlio Botas
    • 2
  • Hélder Coelho
    • 3
  • Maria José Brito
    • 3
  • Jorge Fonseca
    • 1
    • 4
  1. 1.Gastroenterology DepartmentHospital Garcia de OrtaAlmadaPortugal
  2. 2.Infectiology DepartmentHospital Garcia de OrtaAlmadaPortugal
  3. 3.Pathology DepartmentHospital Garcia de OrtaAlmadaPortugal
  4. 4.CiiEM, Center for Interdisciplinary Research Egas MonizMonte da CaparicaPortugal

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