Saint Michael's Medical Center Newark, NJ, United States
Hossam Abed, MD1, Dema Shamoon, MD1, Omar Al-radideh, MD1, Yatinder Bains, MD1, Mehul Shah, MD2, Theodore Dacosta Jr., MD1 1Saint Michael's Medical Center, Newark, NJ; 2St. Michael's Medical Center, Newark, NJ
Introduction: Chylous ascites is an uncommon entity. It is characterized by high amount of triglycerides which is giving it the milky appearance. It is very rarely reported in literature as a complication of metastatic prostate cancer. Herein we are reporting a unique case of recurrent chylous ascites as a complication of metastatic prostate cancer, which was managed by inserting a long-term peritoneal drain to allow ascites management outside of a hospital setting.
Case Description/Methods: A 65 year old male with past medical history of Hypertension, diabetes mellitus, and prostate cancer with metastasis to the liver and bone on androgen blockade therapy and chemotherapy, with multiple admissions for recurrent malignant ascites accumulation. Presented with worsening abdominal distension, lower extremity edema, and shortness of breath for 1 week. He was found to have massive ascites which was tapped and a 12 liters of milky fluid was removed. The ascites fluid analysis was significant for a triglycerides level of 394 mg/dl, serum triglycerides level was 41 mg/dl, Albumin level in the serum was 1.5 g/dl and 1 g/dl in the ascites fluid, making Serum ascites albumin gradient (SAAG) of 0.5, total ascites protein of 3.1 g/dl. White blood cells count in the was 550/ mm3 with 95% being lymphocytes, and the ascites fluid culture was negative, cytology showed malignant cells. He ultimately underwent Pleurx insertion into the peritoneal cavity by interventional radiology.
Discussion: Chylous ascites defines as peritoneal fluid that consists of high amount of triglyceride giving its milky appearance. Pathophysiology of chylous ascites involves obstruction of lymph flow leading to leakage from lymphatics to peritoneal cavity, or acquired thoracic duct obstruction due to surgery or trauma cause direct leakage to lymphoperitonial fistula. Progressive and painless abdominal distention is considered the most common presentation, but patients may also complain of weight gain, abdominal pain and early satiety. Paracentesis is usually characterized by cloudy milky colored fluid, triglyceride above 200 mg/dl, cholesterol level is low (ascites/serum ration < 1) total protein 2.5-7 g/dl. Up to our knowledge there are only a few reported cases chylous ascites caused by metastatic prostate cancer. Chylous ascites is an uncommon presentation of metastatic malignancy, and can very rarely presents with metastatic prostate cancer which makes our case more unique and exceptional.
Figure: Milky colored fluid aspirated from chylous ascites
Hossam Abed indicated no relevant financial relationships.
Dema Shamoon indicated no relevant financial relationships.
Omar Al-radideh indicated no relevant financial relationships.
Yatinder Bains indicated no relevant financial relationships.
Mehul Shah indicated no relevant financial relationships.
Theodore Dacosta Jr. indicated no relevant financial relationships.
Hossam Abed, MD1, Dema Shamoon, MD1, Omar Al-radideh, MD1, Yatinder Bains, MD1, Mehul Shah, MD2, Theodore Dacosta Jr., MD1. P0854 - Chylous Ascites as a Rare Complication of Metastatic Prostate Cancer, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.