Colin G. Knight, M.D.; Laurel Omert M.D.

From the Allegheny General Hospital Shock Trauma Center, Pittsburgh, PA, USA

Chylous ascites has many etiologies including malignancy, infection, and inflammation. We present a case of chylous ascites following trauma. A 36 year-old man was struck by an automobile sustaining a flail chest. He was initially treated with positive pressure ventilation and bilateral tube thoracostomies at a referring hospital and transferred to our center. Computerized tomographic (CT) scan confirmed bilateral pneumothoraces and demonstrated a grade V right kidney laceration with a large Zone II retroperitoneal hematoma. The patient was taken for celiotomy because of hemodynamic instability and underwent a nephrectomy due to the expanding hematoma. His post-operative course was complicated by multiple organ failure from which he eventually recovered. He was discharged to a rehabilitation facility two months after admission.

The patient returned several weeks later with complaints of nausea and vomiting. Physical exam was remarkable for tachycardia and tachypnea as well as a distended, tight abdomen. CT revealed a large volume of ascites with a fat-fluid level. A CT guided drainage confirmed the diagnosis of chylous ascites. Following removal of the fluid the patient's symptoms and vital signs normalized. He was treated by placement on a low-triglyceride, salt-restricted diet and had complete cessation of the chyle leak within one week.



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