Midgut Volvulus Complicated With Chylous Ascites in a Sexagenarian-A Case Report

Joseph Lin ； Tung-Yen Lee

《The Changhua Journal of Medicine》 18卷1期 (2020/03) Pp. 14-17

https://doi.org/10.6501/CJM.202003_18(1).0003

摘要

Chylous ascites are defined as leakage of the triglyceride-rich lymph into the peritoneal cavity; this is a rare medical finding associated with acute bowel obstruction in adults. Our patient was a 68-year-old man with chief complaints of abdominal distension and abdominal pain. Abdominal contrast-enhanced computed tomography showed twisting of the superior mesenteric vessels encircled by collapsed loops of small bowel. An adhesive band approximately 50 cm distal to the Treitz ligament was located, around which a volvulus of the mid-portion of the small intestine was found, in a counterclockwise fashion. Approximately 100 mL of milky-white peritoneal fluid were found intraoperatively, and enterectomy was not performed, as there was no sign of bowel ischemic necrosis. The patient's postoperative course was uneventful, and he was discharged on the sixth postoperative day. Our case demonstrated that a midgut volvulus with chylous ascites may manifest as acute abdominal pain causing peritonitis with free fluid. However, it is rarely considered as a differential diagnosis before surgery. Studying ascitic fluid, both pre- and intraoperatively, is essential in order to create a suitable surgical plan, as the presence of chylous ascites in bowel obstruction may imply an early phase of mesenteric strangulation, and early intervention may prevent bowel necrosis and enterectomy.

關鍵字

chylous ascites ； midgut volvulus ； triglyceride