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  Table of Contents  
LETTER TO THE EDITOR
Year : 2015  |  Volume : 52  |  Issue : 1  |  Page : 109
 

Duodenal adenocarcinoma: A rare cause of chyloperitoneum (chylous ascites)


Department of Medical Oncology, Ankara Numune Education and Research Hospital, Ankara, Turkey

Date of Web Publication3-Feb-2016

Correspondence Address:
B Civelek
Department of Medical Oncology, Ankara Numune Education and Research Hospital, Ankara
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.175565

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How to cite this article:
Civelek B, Aksoy S, Kos T, Arık Z, Akıncı M B, Uncu D, Özdemir N, Cihan S, Zengin N. Duodenal adenocarcinoma: A rare cause of chyloperitoneum (chylous ascites). Indian J Cancer 2015;52:109

How to cite this URL:
Civelek B, Aksoy S, Kos T, Arık Z, Akıncı M B, Uncu D, Özdemir N, Cihan S, Zengin N. Duodenal adenocarcinoma: A rare cause of chyloperitoneum (chylous ascites). Indian J Cancer [serial online] 2015 [cited 2020 Mar 28];52:109. Available from: http://www.indianjcancer.com/text.asp?2015/52/1/109/175565


Sir,

Chylous ascites is a milky-appearing peritoneal fluid that is rich in triglycerides. Malignancy is a common cause of chylous ascites in adults. Lymphoma accounted for at least one-half to one-third of the cases. The mechanism is thought to be due to the destruction or obstruction of the lymphatics.[1] Here we present a case of acute chylous peritonitis in a patient with advanced duodenal carcinoma who presented with signs and symptoms of peritonitis and ascites.

The patient, a 42-year-old man, was admitted to hospital with a three-month history of increasing abdominal distension and shortness of breath. On physical examination his performance status was ECOG 2, he had abdominal distention, ascites and rales. Other physical examination seems normal. The initial blood laboratory results showed a total leukocyte count of 14300/L with 62% neutrophils, Hb 13,8 g/dL, platelet count 75,000/L, Na 143 mM/L, K 3.9 mM/L, Cl 103 mM/L, BUN 33 mg/dL, creatinine 1,05 mg/dL, glucose 116 mg/dL, AST 167 IU/L, ALT 135 IU/L, and total bilirubin 1,8 mg/dL LDH: 1765 IU/l. Upper gastrointestinal system endoscopy shows diffuse edematous lesion in second part of duodenum. Histopathological examination was consistent with poor differentiated adenocarcinoma. Abdominal computerize tomography showed multiple lymphadenopaty in portal hilar; perisplenic, peripancreatic and mesenteric region with a 47 × 25 mm greatest dimension and massive ascites.

Paracentesis elicited creamy white ascitic fluid with a triglyceride level of 2000 mg per dl and a cell count of 1000 cells per dl. Patient status progressively deteriorated and died one week.

Chylous ascites as presenting symptom of a duodenal adenocarcinoma is the first report in our knowledge. Chylous ascites is an uncommon finding, with an incidence of one in 20,000 hospital admissions.[2] Paracentesis is the most important diagnostic modality and reveals milky peritoneal fluid with a triglyceride concentration two to eight times that of plasma. Malignant lymphoma is the most common cause of chylous ascites and accounts for 50% of cancer-related cases.[3] Other malignancies such as colon, pancreatic, ovarian cancers, and intestinal carcinoid, Kaposi sarcoma, and lymphangiomyomatosis can also cause chylous ascites.[4]

Various approaches have been used in the management of chylous ascites like dietary manipulation, hyperalimentation, paracentesis, diuretic therapy, salt restriction, radiotherapy and radio therapy.[5] We decided to control ascites with paracentesis and salt restriction and diuretic administration, and chemotherapy but no interventions control ascites and improve symptoms. Patients with lymphoma and chylous ascites, using specific antitumor chemotherapy together with diuretics and salt restriction may control ascites. But treatment should be individualized and adjusted to the severity of lymphatic leakage and its consequences. The outcome mostly depends on the underlying pathological condition.

 
  References Top

1.
Almakdisi T, Massoud S, Makdisi G. Lymphomas and Chylous Ascites: Review of the literature. Oncologist 2005;10:632-5.  Back to cited text no. 1
    
2.
Lovat LB. A case of chylous ascites. BMJ 1993;307:495-7.  Back to cited text no. 2
    
3.
Aalami OO, Allen DB, Organ CH. Chylous ascites: A collective review. Surgery 2000;128:761-8.  Back to cited text no. 3
    
4.
Kim HS, Park MI, Suh KS. Lymphangiomyomatosis arising in the pelvic cavity: A case report. J Korean Med Sci 2005;20:904-7.  Back to cited text no. 4
    
5.
Hufford S, Hu E. Lymphoma and chylous ascites. West J Med 1988;148:581-3.  Back to cited text no. 5
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