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CC BY 4.0 · European J Pediatr Surg Rep. 2024; 12(01): e1-e3
DOI: 10.1055/a-2221-9682
Video Case Reports

Massive Chylous Ascites in a 9-Year-Old Girl with Malrotation—A Case Report

Hans Winberg
1   Pediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
2   Department of Pediatric Surgery, Skånes Universitetssjukhus Lund, Lund, Sweden
,
Pär Gerwins
3   Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
,
Kristine Hagelsteen 
1   Pediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
2   Department of Pediatric Surgery, Skånes Universitetssjukhus Lund, Lund, Sweden
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Abstract

Malrotation leading to massive chylous ascites is rare. A 9-year-old girl was investigated for slowly increasing abdominal distension under a year. She had no vomiting, weight loss, or pain, but was bothered in social situations. Medical investigations, including ultrasound and computed tomography scans, revealed massive ascites. Laparocentesis yielded milk-colored fluid, confirmed as lymph through laboratory analysis. A complete blood count, liver function and hematologic parameters, chyle cytology, bacterial cultures, and polymerase chain reaction for tuberculosis were all within normal limits.

She was referred to a tertiary center for vascular anomalies. A dynamic contrast-enhanced magnetic resonance lymphangiography showed normal lymphatic anatomy without leakage or flow obstruction. A whole-body magnetic resonance imaging revealed a central mesenteric rotation.

She was referred to a tertiary center for pediatric surgery, where a laparoscopic Ladd's procedure was performed using a new 5 mm pediatric sealing device, along with an appendectomy using a 5 mm stapler. To derotate the bowel, fenestrations were created in compartments containing a substantial amount of chyle and ascites, resulting in the drainage of 2.4 L of fluid. She was discharged the day after surgery and has been in good health for 1 year. We present a video illustrating the Ladd's procedure steps in this patient.

Keywords

malrotation - minimal invasive surgery - chylous - sealing device - Ladd's procedure

Note

Every pediatrician and pediatric surgeon should be aware of malrotation as the cause of chylous ascites in children. ([Supplementary Fig. S1], available in the online version)


Supplementary Material



Publication History

Received: 18 March 2023

Accepted: 21 October 2023

Accepted Manuscript online:
04 December 2023

Article published online:
10 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Alshahrani SM, Saeed MA, Alghamdi AS, Alameri MS. Intestinal malrotation causing chylous ascites in an adolescent: a case report. Int J Surg Case Rep 2020; 77: 894-898
    CrossrefPubMedGoogle Scholar
  • 2 Long L, Zhen C, Yandong W, Ning D, Qi L, Qing G. Congenital chylous ascites in infants: another presentation of intestinal malrotation. J Pediatr Surg 2018; 53 (03) 537-539
    CrossrefPubMedGoogle Scholar
  • 3 Harino Y, Kamo H, Yoshioka Y. et al. Case report of chylous ascites with strangulated ileus and review of the literature. Clin J Gastroenterol 2015; 8 (04) 186-192
    CrossrefPubMedGoogle Scholar
  • 4 Hayama T, Shioya T, Hankyo M. et al. Primary volvulus of the small intestine exhibiting chylous ascites: a case report. J Nippon Med Sch 2017; 84 (02) 83-86
    CrossrefPubMedGoogle Scholar
  • 5 Aboagye J, Goldstein SD, Salazar JH. et al. Age at presentation of common pediatric surgical conditions: reexamining dogma. J Pediatr Surg 2014; 49 (06) 995-999
    CrossrefPubMedGoogle Scholar