Spontaneous resolution of chylous ascites following delivery: a case report

Chyloascites or chyloperitoneum, which can be caused by different factors, is a process of eruption of one or many lymphatic vessels spontaneously. Malignant processes, inflammation or trauma can cause a sudden burst in a lymphatic vessel which will lead to a collection of milky fluid in any space of the human body with the abdominal cavity being the most common location. Chyloperitoneum is rare during pregnancy and this case is the fifth described worldwide. We describe a case of chyloascitis in a 27-year-old primigravida Middle Eastern woman, found coincidentally during cesarean section. Free fluid was found in the abdominal cavity with no source of trauma or masses. An abdominal drain remained in situ for six days. The milky fluid was sent for biochemical analysis and found to be positive for triglycerides. Her postoperative course was uneventful. A computed tomography scan of the abdomen and pelvis was negative for fluid collection, tumors or other lesions. While this is the fifth case of chylous ascitis associated with pregnancy, it is the second found to be spontaneous with no obvious cause described to date. Chylous ascitis is not always associated with tumors, inflammation or trauma. It can, although rarely, be associated with pregnancy. The course of pregnancy is usually uncomplicated in the cases published to date. This fifth case serves as a reminder for obstetricians, when presented with similar findings, to consider chylous ascitis as one of the differential diagnoses. Early diagnosis and appropriate treatment is vital for improved outcomes for the mother and the fetus.