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Background: Chylous ascites (CA) is very rare in the pediatric population. It is defined as whitish ascitic fluid with lymphocyte predominance. Congenital CA is probably the most common cause of CA in children. We report a case of an infant with CA; the cause of which remains unidentified, with full recovery. We have included a relevant literature review as well. Case Presentation: A previously well 4-month-old baby girl was referred for worsening ascites. Despite extensive workup, no cause was found. Treatment options including diuretics, medium chain triglyceride formula (MCT) feeds, abdominal paracentesis, and total parenteral nutrition (TPN) were attempted. She recovered fully with no residual morbidity. Conclusion: CA very rare in the pediatric population. Extensive workup excluded known causes and the yield was negative. Treatment is mainly supportive. MCT formula, fasting, and TPN were reported to have variable effects. Surgery could required in limited cases. [ABSTRACT FROM AUTHOR]

Congenital chylous ascites (CCA) is a rare condition seen in the neonatal period. The pathogenesis is primarily related to congenital intestinal lymphangiectasis. Conservative treatment of chylous ascites involves paracentesis, total parenteral nutrition (TPN), medium-chain triglyceride (MCT)-based milk formula, use of somatostatin analogue and octreotide. Surgical treatment is considered when conservative treatment fails. We describe a laparoscopic treatment of CCA using the fibrin glue technique. A male infant, in whom foetal ascites was detected at 19 weeks of gestation, was born by caesarean section at 35 weeks of gestation weighing 3760 g. There was evidence of hydrops in the foetal scan. A diagnosis of chylous ascites was made by abdominal paracentesis. A magnetic resonance scan was suggestive of gross ascites, and no lymphatic malformation was identified. TPN and octreotide infusion was started and continued for 4 weeks, but the ascites persisted. The failure of conservative treatment led us to perform laparoscopic exploration. Intraoperatively, chylous ascites and multiple prominent lymphatic vessels around the root of the mesentery were noted. The fibrin glue was applied over the leaking mesenteric lymphatic vessels in the duodenopancreatic region. Oral feeding was started from post-operative day 7. After 2 weeks of the MCT formula, ascites progressed. Thus, laparoscopic exploration was necessary. We introduced an endoscopic applicator for fibrin glue and applied it into the place of leakage. The patient was doing well with no appearance of ascites reaccumulating and was discharged on the 45th post-operative day. Follow-up ultrasonography (1st, 3rd and 9th months after discharge) showed a small amount of ascitic fluid but with no clinical significance. Laparoscopic localisation and ligation of leakage sites could be difficult, especially in newborns and young infants due to the small size of lymphatic vessels. The use of fibrin glue to seal the lymphatic vessels is quite promising. [ABSTRACT FROM AUTHOR]

Neonatal ascites is commonly the result of hematologic disorders that lead to hydropsfetalis; less frequently it may be caused by non-immunological disorders. One of the rare causes of non-immunological disorders aremetabolical diseases. We hereby present the case of a 5 month old infant in which 4D ultrasound performed at 24 weeks of gestation revealed increased fetal abdominal circumference by fluid accumulation in peritoneal cavity. The presence of congenital isolated ascites along with the peculiar aspect of the infant - dysmorphic features that included frontal bossing, depressed nasal bridge and broad nasal tip, large low-set ears, long philtrum, macroglossia, broad hands and feet, brachydactyly and joint contractures, coarse skin, hepatosplenomegaly, and inguinal hernia, along with biochemical analysis of β-galactosidase enzyme in leucocytes lead to the diagnosis of GM1 gangliosidosis. [ABSTRACT FROM AUTHOR]

A case of a neonate with congenital chylous ascites resulting from primary lymphatic dysplasia is described. The baby also presented with a sludge ball in the gallbladder that eventually progressed to gallstones. The association of chylous ascites with cholelithiasis in this neonate is discussed. [ABSTRACT FROM AUTHOR]