Mesenteric lymphatic malformation mimicking chylous ascites: a case report

Mesenteric lymphatic malformations, previously referred to as mesenteric cysts, represent rare clinical entities. While these malformations are often asymptomatic, they can occasionally present with acute abdominal symptoms. The growth patterns as well as the fluid composition may vary. We present a case involving a 5-year-old patient who experienced progressive abdominal distention accompanied by an ascitic wave (initially misdiagnosed as ascites). A paracentesis was conducted, producing a cloudy fluid, which raised concerns for chylous ascites, leading to additional diagnostic assessments. Surgical intervention became necessary when laboratories, fluid analyses, and imaging studies failed to provide a conclusive diagnosis. Ultimately, laparoscopy confirmed the presence of a mesenteric lymphatic malformation. Differentiating between mesenteric lymphatic malformations and chylous ascites poses significant challenges, highlighting the importance of considering mesenteric lymphatic malformations as a crucial differential diagnosis for chylous ascites. This paper aims to improve the accuracy of diagnoses to minimize the occurrence of unnecessary interventions. Importantly, the adoption of single-incision laparoscopy has proven to be a safe method, yielding favorable outcomes for this patient. However, continued research is essential to deepen our understanding and establish effective management protocols for these distinctive conditions.