Management of large congenital chylous ascites in a preterm infant: fetal and neonatal interventions

2020 ◽  
Vol 13 (9) ◽  
pp. e235849
Author(s):  
Loo Sooklin ◽  
Amudha Jayanthi Anand ◽  
Victor Samuel Rajadurai ◽  
Suresh Chandran
Keyword(s):  
Newborn Infants ◽  
Medium Chain Triglyceride ◽  
Chylous Ascites ◽  
Normal Growth ◽  
Genetic Syndromes ◽  
Formula Milk ◽  
Lymphatic Duct ◽  
Octreotide Therapy ◽  
Abdominal Paracentesis

Congenital chylous ascites is a rare cause of ascites in newborn infants. Its aetiology varies from localised leaky lymphatic duct to genetic syndromes. Most of these cases have transient ascites resolving over time with conservative management but some may progress needing medical as well as surgical treatment. We describe a case of antenatally detected large fetal ascites necessitating abdominal paracentesis and amnioreduction. Marked respiratory distress at birth required urgent abdominal paracentesis to relieve symptoms. The infant initially showed a good response to medium chain triglyceride (MCT) based formula milk feeds. Feeds were discontinued for 3 weeks due to sepsis with ileus. On recovery, recommencement of feeds resulted in reaccumulation of ascites. As the response to MCT-based formula was inadequate, octreotide therapy was initiated. Ascites showed remarkable resolution over the next 2 weeks and was discharged home. Follow-up at 5 years of age revealed normal growth and neurodevelopment.

scholarly journals Congenital chylous ascites: a case report

2019 ◽  
Vol 6 (5) ◽  
pp. 2203
Author(s):  
Rajsree Sreedevi ◽  
Jose Paul ◽  
George Jose ◽  
Abdul Majeed
Keyword(s):  
Case Reports ◽  
Chylous Ascites ◽  
Individual Therapy ◽  
Long Chain Fatty Acids ◽  
Formula Milk ◽  
Management Plans ◽  
Gradual Introduction ◽  
Late Preterm Newborn ◽  
Per Oral

Due to the rarity of congenital chylous ascites and the lack of standards in diagnosis and therapy, this disease constitutes a medical challenge and individual therapy seems to be extremely important. A late preterm newborn with antenatally diagnosed ascites was born and chylous ascites was diagnosed after feeds were started. The baby was managed initially with nil per oral, parenteral nutrition and octreotide, followed by adding MCT formula feeds. Considering the rarity of neonatal chylous ascites and the non-uniformity in management plans and follow up, more case reports need to be published. Also, MCT formula, the main stay of management has to be discontinued as soon as possible with gradual introduction into breast feeds or normal newborn formula milk as long chain fatty acids are essential for optimal brain growth in newborns. 

A case report of refractory congenital chylous ascites in infant – surgical treatment with Fibrin glue

2021 ◽  
Vol 148 (12) ◽  
pp. 128-133
Author(s):  
Nguyen Van Tinh ◽  
Nguyen Thi Viet Ha ◽  
Dang Thuy Ha ◽  
Le Dinh Cong ◽  
Vu Manh Hoan ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Fibrin Glue ◽  
Medium Chain Triglyceride ◽  
Chylous Ascites ◽  
Abnormal Development ◽  
Bowel Rest ◽  
No Gold Standard ◽  
Abdominal Paracentesis

Congenital chylous ascites is a rare disease that results from abnormal development of the intra-abdominal lymphatic system. No gold standard treatment has been described so far, however, a combination of medium–chain triglyceride based diet or total parenteral nutrition along with octreotide and abdominal paracentesis is considered as a conservative management. This treatment is often a challenge to physicians since chylous ascites is often refractory and result in malnutrition and immune deficiency because of the loss of proteins and lymphocytes. We report a four-month old boy with congenital chylous ascites who was refractory to medical treatment with prolonged bowel rest, total parenteral nutrition, octreotide and repeated paracentesis. The baby well responded to surgical treatment with application of fibrin glue on the surface area of the leak site and was discharged after 2 month of hospitalization. When following up the patient had no recurrence of the ascites and he was growing up normally.

scholarly journals Congenital chylous as cites in a 3-month-old infant in Zaria: A case report

2021 ◽  
Vol 48 (2) ◽  
pp. 96-98
Author(s):  
S.M. Abdullahi ◽  
H.W. Idris ◽  
S.M. Mado ◽  
A.H. Sadiku ◽  
A. Alfa ◽  
...  
Keyword(s):  
Case Report ◽  
Lymphatic System ◽  
Medium Chain Triglyceride ◽  
Chylous Ascites ◽  
Individual Therapy ◽  
Medium Chain ◽  
Diagnosis And Therapy ◽  
Nutrition Medium ◽  
Per Oral ◽  
Abdominal Paracentesis

Congenital chylous ascites (CCA) is a rare disease that results from the maldevelopment of the intra-abdominal lymphatic system. Due to the rarity of congenital chylous ascites and the lack of standards in diagnosis and therapy, this disease constitutes a medical challenge and individual therapy seems to be extremely important. A 3-month-old girl diagnosed with congenital chylous ascites. She was managed initially with nil per oral, parenteral nutrition, medium chain triglyceride (MCT) containing oil and abdominal paracentesis, followed by octreotide. Medium chain triglyceride formula, the main stay of management was discontinued with gradual reintroduction of breast feeds. This case was selected due to the rarity of CCA and the lack of standards in the diagnosis and therapy.

Complete resolution of acute pancreatitis-induced chylous ascites following transhepatic portal vein stenting

2020 ◽  
Vol 13 (12) ◽  
pp. e235986
Author(s):  
Alexander Tindale ◽  
James Jackson ◽  
Darina Kohoutova ◽  
Panagiotis Vlavianos
Keyword(s):  
Portal Vein ◽  
Complete Resolution ◽  
Chylous Ascites ◽  
Biliary Pancreatitis ◽  
Acute Biliary Pancreatitis ◽  
Portal Vein Stenosis ◽  
First Case ◽  
Vein Stenosis ◽  
Inflammatory Changes

We introduce a case of a 73-year-old man who developed intractable chylous ascites due to portal vein compression as a result of peripancreatic inflammatory changes after acute biliary pancreatitis. After stenting the portal vein stenosis, the chylous ascites improved from requiring weekly paracentesis to requiring no drainage within 4 months of the procedure and at the 15-month follow-up. To our knowledge, it is the first case reported in the literature where portal vein stenting has successfully been used to treat pancreatitis-induced chylous ascites.

scholarly journals Combined Chylothorax and Chylous Ascites Complicating Liver Transplantation: A Report of a Case and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Tommy Ivanics ◽  
Semeret Munie ◽  
Hassan Nasser ◽  
Shravan Leonard-Murali ◽  
Atsushi Yoshida ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Enteral Feeding ◽  
Early Recognition ◽  
Medium Chain Triglyceride ◽  
Serum Triglyceride ◽  
Chylous Ascites ◽  
Abdominal Distension ◽  
Invasive Treatment ◽  
Management Options ◽  
Early Enteral Feeding

Chyle leaks may occur as a result of surgical intervention. Chyloperitoneum, or chylous ascites after liver transplantation, is rare and the development of chylothorax after abdominal surgery is even more rare. With increasingly aggressive surgical resections, particularly in the retroperitoneum, the incidence of chyle leaks is expected to increase in the future. Here we present a unique case of a combined chylothorax and chyloperitoneum following liver transplantation successfully managed conservatively. Risk factors for chylous ascites include para-aortic manipulation, extensive retroperitoneal dissection, use of a Ligasure device, and early enteral feeding as well as early enteral feeding. The clinical presentation is typically insidious and may include painless abdominal distension. Diagnosis can be made by noting characteristic milky white drainage which on laboratory examination has a total fluid triglyceride level >110 mg/dl, an ascites/serum triglyceride ratio of >1 and a leukocyte count in fluid >1000/uL with a lymphocyte predominance. Chyle leaks may lead to significant morbidity and mortality. Numerous management options exist, with conservative nonoperative measurements leading to the most consistent and successful outcomes. This includes a step-up approach beginning with dietary modifications to a low-fat or medium chain triglyceride diet followed by nil per os with addition of total parenteral nutrition and somatostatin analogues such as octreotide. Rarely do patients require more invasive treatment. Early recognition and appropriate management are imperative to mitigate this complication.

Six month follow-up after 111In-DTPA-octreotide therapy in patients with progressive radioiodine non-responsive thyroid cancer: a pilot study

2004 ◽  
Vol 25 (7) ◽  
pp. 683-690 ◽  
Author(s):  
Marcel P.M. Stokkel ◽  
Robbert B.T. Verkooijen ◽  
Hanneke Bouwsma ◽  
Jan W.A. Smit
Keyword(s):  
Thyroid Cancer ◽  
Pilot Study ◽  
Octreotide Therapy

scholarly journals Assessing Normal Growth of Hepatic Hemangiomas During Long-term Follow-up

JAMA Surgery ◽  
2014 ◽  
Vol 149 (12) ◽  
pp. 1266 ◽  
Author(s):  
Hani Y. Hasan ◽  
J. Louis Hinshaw ◽  
Edward J. Borman ◽  
Alison Gegios ◽  
Glen Leverson ◽  
...  
Keyword(s):  
Normal Growth ◽  
Long Term Follow Up ◽  
Hepatic Hemangiomas

Constitutional Delay of Growth: Expected versus Final Adult Height

PEDIATRICS ◽  
1991 ◽  
Vol 87 (1) ◽  
pp. 82-87 ◽  
Author(s):  
Stephen LaFranchi ◽  
Cheryl E. Hanna ◽  
Scott H. Mandel
Keyword(s):  
Adult Height ◽  
Hormone Secretion ◽  
Growth Hormone Secretion ◽  
Human Growth ◽  
Normal Growth ◽  
Bone Age ◽  
Final Adult Height ◽  
Constitutional Delay ◽  
Height Predictions

Constitutional delay of growth and puberty is believed to represent a variation of normal growth, and it is expected that children with this condition will grow for a longer duration than average and reach a height that is normal for their genetic potential. The records of children with constitutional delay of growth and puberty who were initially seen in the Pediatric Endocrine Clinic at the Oregon Health Sciences University between 1975 and 1983 were retrospectively reviewed. Criteria for study included a height more than 2 SD below the mean, a significantly delayed bone age, and a normal growth velocity on follow-up. Forty-two subjects were located and final adult height measurements were obtained. At contact, the 29 male subjects (mean age = 23.9 years) were 169.5 ± 4.5 cm tall (mean ± SD), and the 13 female subjects (mean age = 20.5 years) were 156 ± 3.8 cm tall. Adult height predictions during follow-up, using either the Bayley-Pinneau or Roche-Wainer-Thissen method, were close to final adult heights. The males were 1.2 SD and the females 1.3 SD below the 50th percentile as adults. This finding was not fully explained by genetic short stature; the males fell 5.1 cm and the females 5.3 cm below target heights based on midparental heights. It is concluded that this discrepancy is most likely explained by a selection bias of the shortest children referred to and observed in a subspecialty clinic, although a defect in human growth hormone secretion or function in children at the far end of the spectrum of constitutional delay of growth and puberty cannot be excluded.

scholarly journals Follow-up of Newborns, Infants, and Children with Sepsis

2017 ◽  
Vol 07 (01) ◽  
pp. e38-e41
Author(s):  
P. Dahlem ◽  
P. Biggar
Keyword(s):  
Survival Rates ◽  
Newborn Infants ◽  
Infants And Children ◽  
Older Children ◽  
Follow Up Studies ◽  
Related Quality ◽  
Health Related ◽  
Considerable Impact

AbstractMortality in newborn infants and children with sepsis is high with survival rates of generally more than 50% in recent studies. Longitudinal follow-up studies have the potential to reveal short-term and lifelong physical, mental, and psychological sequelae. Although no comprehensive follow-up research has yet been performed, a small number of follow-up studies have shown that there is a considerable impact on the patients' lives and their families after hospital discharge. Health-related quality of life also seems to be affected; however, it does not correlate with severity of sepsis or handicap per se. Prematurely born infants, who can develop sequelae directly attributable to prematurity and its consequences, suffer differently from sepsis-related lifelong sequelae compared with older children. Fortunately, time may heal some wounds due to the effect of growth in children. In future, large centers should establish structural follow-up programs for clinical and research purposes to learn more about the needs of affected children and their families.

The changing phenotype in diploid/triploid mosaicism may mimic genetic syndromes with aberrant genomic imprinting: Follow up in a 14-year-old girl

2008 ◽  
Vol 51 (6) ◽  
pp. 573-579 ◽  
Author(s):  
Olaf Rittinger ◽  
Gabriela Kronberger ◽  
Andrea Pfeifenberger ◽  
Dieter Kotzot ◽  
Christine Fauth
Keyword(s):  
Genomic Imprinting ◽  
Genetic Syndromes
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