1261 Chylous Ascites in the Setting of a Pancreatic Pseudocsyt: A Rare Cause of an Even Rarer Condition

Abstract

INTRODUCTION: Chylous ascites is a rare entity. It is formed when triglyceride-rich fluid enters the peritoneal cavity. Although the most common cause of the same is trauma to the lymphatic ducts, rarer causes still exist for the same. CASE DESCRIPTION/METHODS: Our case is a 63-year-old lady who was admitted with a provisional diagnosis of severe pancreatitis with multiorgan failure. On admission, her lab results were significant for a WBC count of 23.7 and a lipase level of over 30,000. While in the hospital she had also developed acute kidney injury, requiring hemodialysis and a pulmonary embolism. On being managed for th aforementioned, she also subsequently developed an infected pancreatic pseudocyst with culture results being positive for Enterococcus spp. and Staphylococcus epidermidis. A few weeks later, the patient underwent repeat abdominal imaging to assess for the interval change in the pancreatic pseudocyst. CT of the Abdomen revealed the presence of ascites. It was initially thought to be a gynecological malignancy, but Ascitic fluid analysis revealed elevated triglyceride levels and was unremarkable for the presence of any malignant cytological cells. A diagnosis of chylous ascites was made, which had resolved on drainage of the pseudocyst. The CT of the abdomen also revealed the presence of necrotizing pancreatitis, which appeared to have resolved after the draiange of the pseudocyst. DISCUSSION: In summary, although the most common causes of chylous ascites are either malignancy or iatrogenic trauma, our case presents itself to be somewhat of an enigma. Our working hypothesis is that the pseudocyst may have potentially expanded to cause traumatic injury to the lymphatic channels. Although exceptionally rare, there have been a total of 13 cases of chylous ascites associated with pancreatitis, of which 7 of them happen to be chronic. This is the first case of an association with a pancreatic pseudocyst. Further, even though chylous ascites due to necrotizing pancreatitis has been reported, the fact that her symptoms resolved on drainage of the pseudocyst favours the latter as the etiological agent for the ascites.