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MedPulse - International Medical Journal, ISSN 2348-2516 E-ISSN: 2348-1897

Volume 1, Issue 8, June 2014 pp 396-398

Case Report

A rare case of post traumatic chylous ascitis –managed conservatively

G. G. Gumaste¹, T. S. Chhabda², Pritam Patil³

¹Professor, ²Associate Professor, ³Resident, Department of Surgery, MGM Medical College, Aurangabad, Maharashtra, INDIA.

Academic Editor : Dr. Bhanap P. L.

Context: 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. Report: 54 years male came with h/o blunt trauma abdomen 2 days back due to fall from a two wheel. USG suggested haemoperionium (200-300 cc). X-ray chest was normal. After 4 day of trauma one fine morning he suddenly developed breathlessness/fever/tachycaedia. USG suggested haemoperitonium (600 cc) and x-ray chest- B/L pleural effusion. C.T. (abdomen + pelvis) - haemoperitonium. no obvious organ injury. Possibility of messenteric vessel injury. He underwent an emergency diagnostic laparoscopy.B/L ICD were inserted which drained 750ml fluid on each side. and about 1-1.5 litre free fluid in peritoneal cavity which was drained out and B/L drains were kept. On pod 7 there was milky white fluid in both abdominal drains which was appx 500ml/day. Test of the fluid showed TG-207 serum lipase-1047.he was put on TPN and kept NBM for almost 20 days. On post op day 32 the drain were dry. He was discharged home on pod 35 comfortably. Conclusion: Post traumatic chylous ascitis should always be managed conservatively by total bowel rest and TPN, surgery should be considered only if conservative management fails