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132306

Management and Outcome of Chylous Ascites in Children: A CARE compliant Case Series

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Last updated: 22 Jan 2023

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Abstract

Background: Chylous ascites (CA) is accumulation of lipid rich lymph in peritoneal cavity. CA is rare among children. In pediatric age, causes of CA varies according to the age group, leading primary causes include congenital malformation of lymphatic system, and less likely lymphatic obstruction such as intestinal malrotation, gastroschisis, infections or trauma of thoracic duct. 
Aim of the work: We aim to report outcome of congenital CA in a pediatric cohort.
Material and Methods: Retrospective analysis of data of 4 children (4 boys) who presented by CA to New Children Hospital, Cairo University during 2010- 2018. 
Results: Duration of follow up of the boys was 6.5, 5, 2.5, and 0.25 years respectively. All presented by abdominal distention and diagnostic tapping of ascitic fluid revealed triglyceride level more than 200 mg%, protein more than 2 g% and/or a cell count greater than 500 /cmm with a predominance of lymphocytes (> 80%). Lymphatic scintigraphy in 3 of them revealed no abnormality in lymph drainage. The course of disease was punctuated by chylothorax, and chylous hydrocoele in all 4 cases. All 4 did not respond to medium chain triglyceride based diet. One child underwent peritenovenous shunt, and the other 3 responded to somatostatin analogue octreotide SC injections during hospital stay and maintenance therapy. Last child was lost to follow up. All other 3 are fine with minimal complications and living with mild peritoneal ascites. 
Conclusion: Somatostatin analogue therapy provided well-tolerated non-invasive control of congenital CA in our studied pediatric cohort. Surgical intervention should be restricted to those with underlying surgical cause and in those failing to respond to medical treatment.

DOI

10.21608/cupsj.2020.31018.1001

Keywords

Primary chylous ascites, peritoneo-venous shunt, pediatric neonate, somatostatin, Medium chain triglycerides based diet MCTs, Lymphatic scintigraphy

Authors

First Name

Magd

Last Name

Kotb

MiddleName

A.

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt

Email

magdkotb@kasralainy.edu.eg

City

Cairo

Orcid

https://orcid.org/00

First Name

Dalia

Last Name

Mosallam

MiddleName

S.

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt

Email

daliamosalam@hotmail.com

City

-

Orcid

https://orcid.org/00

First Name

Heba

Last Name

Ragab

MiddleName

Amin

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt

Email

drhebaaminragab@gmail.com

City

-

Orcid

-

First Name

Hend

Last Name

Abd El Baky

MiddleName

-

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt

Email

hend.elhossainy@cu.edu.eg

City

Cairo

Orcid

https://orcid.org/my

First Name

Ahmed

Last Name

El Hatw

MiddleName

-

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt

Email

ahmed.m.abdelmutae@kasralainy.edu.eg

City

-

Orcid

-

First Name

Alaa

Last Name

Hamza

MiddleName

F.

Affiliation

Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Email

shamza@idsc.net.eg

City

-

Orcid

-

First Name

Hesham

Last Name

Abd El Kader

MiddleName

-

Affiliation

Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Email

heshamabdelkader@yahoo.com

City

-

Orcid

-

First Name

Gamal

Last Name

El Tagy

MiddleName

-

Affiliation

Department of Pediatric Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt

Email

geltagy@gmail.com

City

-

Orcid

https://orcid.org/0

First Name

Haytham

Last Name

Esmat

MiddleName

-

Affiliation

Department of Pediatric Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt

Email

haythamesmate@yahoo.com

City

-

Orcid

-

First Name

Sherif

Last Name

Shehata

MiddleName

-

Affiliation

Department of Pediatric Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt

Email

sherifshehata2001@yahoo.com

City

-

Orcid

https://orcid.org/00

First Name

Nahla

Last Name

Sabry

MiddleName

I.

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt

Email

nahla595@gmail.com

City

-

Orcid

0000-0003-2165-3986

Volume

1

Article Issue

1

Related Issue

19715

Issue Date

2021-01-01

Receive Date

2020-05-26

Publish Date

2021-01-01

Page Start

34

Page End

40

Print ISSN

2805-279X

Online ISSN

2682-3985

Article File

CUPSJ_Volume 1_Issue 1_Pages 34-40.pdf

PDF . 793.5kB

Link

https://cupsj.journals.ekb.eg/article_132306.html

Detail API

https://cupsj.journals.ekb.eg/service?article_code=132306

Order

6

Type

Case Report

Type Code

1,279

Publication Type

Journal

Publication Title

Pediatric Sciences Journal

Publication Link

https://cupsj.journals.ekb.eg/

MainTitle

-

Details

Type

Article

Created At

22 Jan 2023