Fetal chylous ascites may redevelop only after birth
AbstractCongenital chylous ascites is a rare condition. We describe a case in which fetal ascites was found on a routine antenatal ultrasound, with all abnormalities resolving by 36 weeks’ gestation. No investigations or treatment for the ascites was undertaken after the baby´s birth. At the age of 3 months, when the baby underwent surgery for bilateral inguinal hernias and hydrocele, milky fluid was drained from the hernia sac. Laboratory and ultrasound investigations confirmed the presence of a significant amount of chyle in the peritoneal cavity. Congenital chylous ascites was treated by means of a diet based on medium chain triglycerides. By the age of 6 months, the fluid in the abdomen had resolved. However, it partly reappeared once a normal mixed diet was allowed. A minimal amount of fluid in the lower abdominal cavity was consistently found up to the age of 22 months. The fluid had finally disappeared by the age of 30 months when the child was generally in good health and developing normally. We conclude that congenital chylous ascites may be diagnosed prior to birth but may become more clinically significant only after birth, when its severity is enhanced by feedings of milk containing long chain fats. We recommend a thorough postnatal evaluation and follow-up in all infants diagnosed with fetal ascites, so that appropriate and timely management decisions can be made, if the chylous origin of the ascites is confirmed.