Chylous ascites usually occurs when there is massive obstruction of abdominal lymphatic drainage. It is a milky white ascites, rich in chylomicrons from mesenteric lymphatics.
It is usually secondary to malignant involvement of the para-aortic lymph nodes by lymphoma or metastatic testicular tumour.
Less frequently, it is caused by:
Treatment is surgical. Primary fistulas where present should be closed with nonabsorbable sutures. When surgery is unsuccessful, a Leveen peritoneal venous shunt should be employed to return accumulated peritoneal lymph to the central circulation.
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