CHYLOPERITONEUM IN NEWBORNS: ETIOLOGY, PATHOGENESIS, DIAGNOSTICS AND TREATMENT



Cite item

Full Text

Abstract

The present article is a literature review on etiopathogenesis, diagnosis, conservative and surgical treatment of chyloperitoneum in newborns. Chyloperitoneum is an extremely rare pathology in children and, not in all cases it is possible to find its cause. The management protocol for chyloperitoneum has not been developed. The most effective approach for managing this disease is a starvation pause, than transfer to full parenteral nutrition, administration of somatostatin (octreotide) and drainage of the abdominal cavity. Conservative therapy may take several months and, its effectiveness reaches 60-100%. Surgical treatment is aimed to indentify a focus of lymph leakage and its elimination; in severe cases, the fibrin glue is used.

About the authors

Y. I. Kucherov

Speransky Children’s Hospital No 9, Ministry of Healthcare of Russian Federation; Pirogov Russian Medical University, Ministry of Healthcare of Russian Federation

Author for correspondence.
Email: ykucherov@mail.ru
Россия

N. V. Kholodnova

Speransky Children’s Hospital No 9, Ministry of Healthcare of Russian Federation

Email: noemail@neicon.ru
Россия

S. R. Adleiba

Speransky Children’s Hospital No 9, Ministry of Healthcare of Russian Federation; Pirogov Russian Medical University, Ministry of Healthcare of Russian Federation

Email: noemail@neicon.ru
Россия

A. L. Belaya

Speransky Children’s Hospital No 9, Ministry of Healthcare of Russian Federation

Email: noemail@neicon.ru
Россия

L. M. Makarova

Speransky Children’s Hospital No 9, Ministry of Healthcare of Russian Federation

Email: noemail@neicon.ru
Россия

M. A. Ovsyannikova

Speransky Children’s Hospital No 9, Ministry of Healthcare of Russian Federation

Email: noemail@neicon.ru
Россия

Yu. V. Zhirkova

Speransky Children’s Hospital No 9, Ministry of Healthcare of Russian Federation; Pirogov Russian Medical University, Ministry of Healthcare of Russian Federation

Email: noemail@neicon.ru
Россия

References

  1. Press O.W., Press N.O., Kaufman S.D. Evaluation and management of chylous ascites. Ann Intern Med. 1982;96:358-64.
  2. Herman T.E., Siegel M.J. Imaging Case Report. Congenital Chylous Ascites. Journal of Perinatology. 2009;. 29:178-80.
  3. Qi H., Bu-jun G., Li-ming L., Zhi-yuan T., Guo-fen Z., Yue-zu F. Successful management of chylous ascites with total parenteral nutrition, somatostatin and fibrin glue. Chin Med J. 2007; 120: 1847-9.
  4. Mouravas V., Dede O., Hatziioannidis H., Spyridakis I., Filippopoulos A. Diagnosis and management of congenital neonatal chylous ascites. Hippokratia. 2012; Apr. 1108-4189
  5. Plummer J.M., McFarlane M.E., McDonald A.H. Chylous ascites associated with chylothorax; a rare sequela of penetrating abdominal trauma: a case report. J Med Case Reports. 2007; 49: 439-45.
  6. Takagi Y., Sato T., Morio Y., Kumasaka T., Mitani K., Miyamoto H., et al. A pleuro-peritoneal communication through the diaphragm affected with lymphangioleiomyomatosis. Intern Med. 2010; 49: 439-45.
  7. Gaty M.G., Hilfiker M.L., Azizkhan R.G., Glick P.L. Successful treatment of congenital chylous ascites with a somatostatin analogue. Pediatr Surg Int. 1996; 11: 396-7.
  8. Petropoulos A.S., Sfougaris D.K., Mouravas V.K. Birth defects of the lymphatic system. In: Gaslem NA, editor. New developments in birth defects research. New York. Nova Science Publishers, Inc. 2007: 1-67.
  9. Kuroiwa M., Toki F., Suzuki M., Suzuki N. Successful laparoscopic ligation of the lymphatic trunk for refractory chylous ascites. J Pediatr Surg. 2007; 42: E15-18.
  10. Alliet P., Young C., Lebenthal E. Chylous ascites: total parenteral nutrition as primary therapeutic modality. Eur J Pediatr. 1992; 151: 213-4.
  11. Chye J.K., Lim C.T., Van der Heuvel M. Neonatal chylous ascites-report of three cases and review of the literature.PediatrSurg Int. 1997; 12: 296-2.
  12. Cochran W.J., Klish W.J., Brown M.R., Lyons J.M., Curtis T. Chylous ascites in infants and children: a case report and literature review. J Pediatr Gastroenterol Nutr.1985; 4: 668-73.
  13. Huang Y., Xu H. Treatment of congenital chylous ascites using total parenteral nutrition and somatostatin: a case report. ZhonghuaErKeZaZhi. 2005; 43: 152-3.
  14. Alamani O.O., Allen D.B., Organ C.H. Jr. Chylous ascites: A collective review. Surgery. 2000; 128: 761-8.
  15. Huang Y., Xu H. Successful Treatment of Neonatal Idiopathic Chylous Ascites with Total Parenteral Nutrition and Somatostatin. HK J Paediatr (new series), 2008; 13: 130-4.
  16. Rocha G., Fernanades P. Procha et al. Pleural effusions in the neonate. Acta Paediatr. 2006; 95: 791-198.
  17. Beghetti M., La Scala G., Belli D. et al. Etiology and management of pediatric chylothorax. J.Pediatr. 2000; 136: 653-8.
  18. Karagol B.S., Zenciroglu A., Gokce S. et al. Therapeutic management of neonatal chylous ascites: Report of a case and review of the literature. Acta Paediatr. 2010; 99: 1307-10.
  19. Bellini C., Hennekam R.C., Fulcheri E. et al. Etiology of nonimmune hydrops fetalis: A systematic review. Am.J.Med.Genet. 2009; A 149А: 844-51.
  20. Bellini C, RC Hennekam: Non-immune hydrops fetalis: A short review of etiology and pathophysiology. Am.J.Med.Genet. 2012; A 158A : 597-605.
  21. Ergaz Z., Bar-Oz B., Yatsiv I. et al. Congenital chylothorax: Clinical course and prognostic significance. Pediatr.Pulmonol. 2009; 44: 806-11.
  22. te Pas A.B., vdVen K., Stokkel M.P. et al. Intractable congenital chylous ascites. ActaPaediatr. 2004; 93: 1403-5.
  23. Yi Cao, Weihui Yan, Lina Lu, Yijing Tao, Wei Lu, Yingwei Chen, PhD, Qingya Tang, Wei Cai. Parenteral nutrition combined with rice soup can be a safe and effective intervention for congenital chylous ascites. Asia Pac J Clin Nutr. 2016; 25(3): 631-5. doi: 10.6133/apjcn.092015.10.
  24. Садовникова И. В., Широкова Н. Ю., Тихомиров Г. В. Врожденный хилезный асцит. Клинический случай. Экспериментальная и клиническая гастроэнтерология: выпуск 113. 2015; (1): 84-7
  25. Said A. Al-Busafi, Peter Ghali, Marc Deschênes, Philip Wong Review Article Chylous Ascites: Evaluation and Management. Hindawi Publishing Corporation ISRN. Hepatology. doi: http://dx.doi.org/10.1155/2014/240473
  26. Cohen M.Jr., “Klippel-Trenaunay syndrome,” American Journal of Medical Genetics. 2000; vo93(3): 171-5.
  27. Beshay V., Beshay J., Rosenberg A. Chylous ascites: a case of child abuse and an overview of a rare condition. J Pediatr Gastroenterol Nutr, 2001; 32: 487-89.
  28. Olazagasti J.C., Fitzgerald J.F., White S.J. et al. Chylous ascites: a sign of unsuspected child abuse. Pediatrics. 1994; 94: 737-39.
  29. CґardenasA., Chopra S. Chylous ascites. American Journal of Gastroenterology. 2002; 97(8): 1896-900,
  30. Drinnen D., Filston H.C. An unusual case of Gastroschisis with gallbladder evisceration and late postrepairchylous. Ascites.J Pediatr Surg. 1997; 32: 1804-5.
  31. Lloyd D.A. Gastroschisis, malrotation and chylous ascites. J Pediatr Surg. 1994; 26: 106-7.
  32. Cristian Ruben Zalles-Vidal, Alejandro Peñarrieta-Daher, Daniel Ibarra-Rios, Emilio Fernandez-Portilla, Eduardo Bracho-Blachet. Chylous Ascites in a Newborn with Gastroschisis. Case Report. Journal of Neonatal Surgery. 2017; 6(1): 16. doi: 10.21699/jns.v6i1.428
  33. Camiel M.R., Benninghoff D.L., Alexander L.L. Chylous effusions, extravasation of lymphographic contrast material, hypoplasia of lymph nodes and lymphocytopenia. Chest. 1971; 59(1): 107-10.
  34. Campisi C., Bellini C., Eretta C. et al: Diagnosis and management of primary chylous ascites. J Vasc Surg, 2006; 43: 1244-48.
  35. Noel A.A., Gloviczki P., Bender C.E., Whitley D., Stanson A.W., Deschamps C. Treatment of symptomatic primary chylous disorder. J Vasc Surg. 2001; 34: 785-91.
  36. McGahren E.D. Ascites. In: Grosfeld JL, O’Neill J.A. Jr, Fonkalsrud E.W., Coran A.G, editors. Pediatric Surgery.6th edition. Philadelphia: Mosby Elsevier. 2006: pp. 1407-13.
  37. Guzoglu N, Erdeve O, Yilmaz Y et al: Intraperitoneal extravasation from umbilical venous catheter in differential diagnosis of neonatal chylous ascites. Acta Paediatr, 2010; 99: 1284.
  38. Amini E, Sohrabvand F, Molaian M, Shabani M. Chylous ascites and gut malrotation. Arch Iran Med. 2005; 8: 323-5.
  39. Gardenas A., Chopra S. Chylous ascites. Clinical review. Am J Gastr. 2002; 97: 1896-9.
  40. Bellini C., Ergaz Z., Radicioni M., Forner-Cordero I., Witte M., Perotti G., Figar T., Tubaldi L., Camerini P., Baroz B., Yatsiv I., Arad I., Traverso F., Bellini T., Boccardo F., Campisi C., Dalmonte P., Vercellino N., Manikanti S., Bonioli E. C. Congenital fetal and neonatal visceral chylous effusions: neonatal chylothorax and chylous ascites revisited: A multicenter retrospective study. Lymphology 2012; 45(3): 91-102.
  41. Richa Bhardwaj, HalehVaziri, ArunGautam, Enrique Ballesteros, David Karimeddini and George Y. Wu. Chylous Ascites: A Review of Pathogenesis, Diagnosis and Treatment. J Clin Transl Hepatol. 2018 Mar 28; 6(1): 105-13. doi: 10.14218/JCTH.2017.00035. Epub 2017 Dec 4.
  42. Mitsunaga T., Yoshida H., Iwai J. et al: Successful surgical treatment of two cases of congenital chylous ascites. J Pediatr Surg, 2001; 36: 1717-19.
  43. Claudio Olivieri, Lorenzo Nanni, Lucia Masini, and Claudio Pintus. Successful management of congenital chylous ascites with early octreotide and total parenteral nutrition in a newborn. BMJ Case Reports. 2012; doi: 10.1136/bcr-2012-006196.
  44. Man DKW, Spitz L.The management of chylous ascites in children. J Pediatr Surg. 1985; 20: 72-5.
  45. Leibovitch I., Mor Y., Golomb J., et al. The diagnosis and management of postoperative chylous ascites. J Urol. 2002; 167: 449-57.
  46. Huang Y., Zhuang S., Li Y., Liu M., Chen H., Du M. Successful management of congenital chylous ascites in a premature infant using somatostatin analogue. Indian J Pediatr. 2011; 78: 345-7. doi: 10.1007/s12098-010-0256-1.
  47. Mishra R., Kumar S.Octreotide in congenital chylous ascites an avoid requirement of total parenteral nutrition. Indian J Gastroenterol. 2007; 26: 299-300.
  48. Liao H.B., Hwang R.C., Chu D.M., Chu M.L., Chu C.C., Hwang E.J. Neonatal chylous ascites: report of two cases. Zhonghua Min Guo Xiao ErKe Yi Xue Hui ZaZhi. 1990; 31: 47-52.
  49. Klenoff-Brumberg H.L., Genen L.H. High versus low medium chain triglyceride content of formula for promoting short term growth of preterm infants. Cochrane Database Syst. Rev 1. (2003), CD002777.
  50. Chan G.M., E. Lechtenberg: The use of fat-free human milk in infants with chylous pleural effusion. J.Perinatol. 27 (2007), 434-236.
  51. Bhatia C., Pratap U., Slavik Z. Octreotide therapy: a new horizon in treatment of iatrogenic chyloperitoneum. Arch Dis Child, 2001; 85: 234-35.
  52. Huang Q., Jiang Z., Jiang J., Li N., Li J. Chylous ascites: Treated with total parenteral nutrition and somatostatin. World J Gastroenterol. 2004; 10: 2588-91.
  53. Purkait R., Saha A., Tripathy I., Roy B. Congenital chylous ascites treated successfully with MCT-Based formula and octreotide. J Indian AssocPediatr Surg. 2014; 19: 175-7. doi: 10.4103/0971-9261.136480.
  54. Ulibarri J.I., Sanz Y., Fuentes C. et al: Reduction of lymphorrhagia from ruptured thoracic duct by somatostatin. Lancet, 1990; 336: 258.
  55. Hwang J.B., Choi S.O., Park W.H. Resolution of refractory chylous ascites after Kasai portoenterostomy using octreotide. J Pediatr Surg. 2004; 39: 1806-7.
  56. Au M., Weber T., Fleming R. Successful use of somatostatin in a case of neonatal chylothorax. J Pediatr Surg. 2003;38: 1106-7.
  57. Goto M., Kawamata K., Kitano M., Watanabe K., Chiba Y. Treatment of chylothorax in a premature infant using somatostatin. J Perinatol. 2003; 23: 563-4. doi: 10.1038/sj.jp. 7210975.
  58. Collard J.M., Laterre P.F., Boemer F., Reynaert M., Ponlot R. Conservative treatment of postsurgical lymphatic leaks with somatostatin-14. Chest. 2000; 117: 902-5. doi: 10.1378/chest.117.3.902.
  59. Huang Y., Zhuang S., Li Y. et al. Successful management of congenital chylous ascites in a premature infant using somatostatin analogue. Indian J Pediatr. 2011; 78: 345-47.
  60. Melo-Filho A.A., Souza I.J.N., Leite C.A.C. et al. Refractory congenital chylous ascites. Indian J Pediatr. 2010; 77(11): 1335-37.
  61. Arevalo R.P., Bullabh P., Krauss A.N. et al. Octreotide-induced hypoxemia and pulmonary hypertension in premature neonates. J Pediatr Surg. 2003; 38: 251-53.
  62. Machmousch M, Amin A, Lanjaoui I, et al. Congenital chylous ascites: report of four cases and review of the literature. Ann Saudi Med.2000; 20: 436-9.
  63. Romanska-Kita J., Borszewska-Kornacka M.K., Dobrzanska A., Rudzinska I., Czech-Kowalska J., Wawrzoniak T. Congenital chylous ascites. Pol J Radiol. 2011; 76: 58-61.
  64. Unger S.W., Chandler J.G. Chylous ascites in infants and children. Surgery, 1983; 93: 455-61.
  65. Antalo B., Croaker D., Squire R. Successful management of congenital chyloperitoneum with fibrin glue. J Pediatr Surg. 2003; 38: E7-8.
  66. Zeidan S., Delarue A., Rome A. et al. Fibrin glue application in the management of refractory chylous ascites in children. J Pediatr Gastroenetrol Nutr, 2008; 46: 478-81.
  67. Rasha Kassem, Abdullah Rajab, Ahamed Faiz, Sunil Yadav Kumar, Sam Aruputha John, Ola Taher. Chylous ascites in an infant e Treated surgically with fibrin glue after failed medical treatment - A case report. Journal of Pediatric Surgery Case Reports. 2017; 19: 25-7.
  68. Fishman S.J., Burrows P.E., Upton J., Hendren W.H. Life-threatening anomalies of the thoracic duct: anatomic delineation dictates management. J Pediatr Surg. 2001; 36: 1269-72.
  69. Gribetz D., Kanof A. Chylous ascites in infancy; with a report of a case with vitamin A absorption study. Pediatrics, 1951; 7: 632.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2019

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies