Int J Surg Case Rep

. 2020;77:894-898. doi: 10.1016/j.ijscr.2020.12.004. Epub 2020 Dec 3. https://pubmed.ncbi.nlm.nih.gov/33395919/

Intestinal malrotation causing chylous ascites in an adolescent: a case report

Saad Mohammed Alshahrani ¹, Mughis Ahmed Saeed ², Abdullah Saleh Alghamdi ³, Mohammed Saad Alameri ³Affiliations expand

• PMID: 33395919
• PMCID: PMC7732965
• DOI: 10.1016/j.ijscr.2020.12.004

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Abstract

Introduction: Intestinal malrotation is a rare etiology of chylous ascites in adolescents. Chylous ascites is caused by lymphatic system disarrangement, which can result in an anomalous build-up of a lymphatic fluid rich in lipid, namely chyle in the peritoneal cavity.

Presentation of case: We present a case of a 16-year-old Saudi Arabian male who came to the emergency department with right upper quadrant pain associated with difficulty in passing stool for one day and a history of congenital diaphragmatic hernia (CDH) repair at the age of 4 months. Free fluid in the abdomen was noticed in the bedside ultrasound. Abdominopelvic computed tomography revealed dilated small bowel loops and a whirl sign of the mesentery, which indicated intestinal torsion. The patient was treated using Ladd’s procedure, and a large volume of chylous fluid was removed from the abdomen. Postoperatively, the abdominal drain revealed no chyle, and the patient was followed-up as an outpatient at which point, he reported no abdominal pain.

Discussion: Intestinal malrotation is more commonly reported in children and associated with congenital chylous ascites. Chylous ascites by itself is a rare occurrence, and very few cases attribute it to intestinal malrotation in adults. Surgical management with Ladd’s procedure is a well-documented surgery in pediatric patients, and yet it was successfully performed in our adolescent patient.

Conclusion: Surgical management of chylous ascites secondary to intestinal malrotation in an adolescent, which is considered novel in this age group, including peritoneal lavage of chyle, resulted in favorable outcomes.

Keywords: Adolescent; Case report; Chylous ascites; Intestinal malrotation.

Copyright © 2020. Published by Elsevier Ltd.