Chylous Ascites in Pediatric Patients: Approach and Management

Abstract Purpose of Review In this review, we highlight the etiology and management of chylous ascites in different pediatric age groups. In infants and young children, congenital chylous ascites is the most common etiology, which develops either due to delayed maturation or malformation of lymph vessels with subsequent extravasation of lymphatic chyle. In older children, acquired causes such as trauma, surgical (iatrogenic injury), inflammatory and neoplastic conditions contribute to chylous ascites in addition to lymphatic dysplasia or malformations. Recent Findings Advanced techniques in imaging and new therapeutic modalities have drastically enhanced our understanding of this rare entity with better outcomes. Summary Paracentesis is diagnostic and reveals a lymphocyte-predominant, triglyceride-rich fluid. Conservative management with dietary modification (formula/diet rich in protein and medium-chain triglycerides and low in long-chain fatty acids) is the first line of management and will suffice in majority of patients with chylous ascites. Lymphoscintigraphy and lymphangiography techniques are usually employed in localizing the lymphatic leak. Somatostatin analogs or mTOR inhibitors can be utilized for patients not responding to dietary therapy. Embolization of leaky lymphatics or microsurgical ligation of the lymphatic duct can be considered if the conservative intervention is not successful in patients with refractory symptoms.