Chyloperitoneum

Chyloperitoneum is characterized by the presence of triglyceride-rich chylomicron particles in the peritoneal cavity, which causes the peritoneal effluent to appear “milky”(1). The potential pathogenesis of chyloperitoneum involves the interruption of lymphatic drainage from the gut to the main lymphatic trunks(1). This could occur spontaneously – particularly in neonates(2)- or as a result of tuberculous peritonitis(3), various medications (4–6), lymphoma or radiation therapy, liver cirrhosis, diet(7)or abdominal trauma(1).

Diagnosis and Management

The diagnosis is suspected by the presence of a milky peritoneal outflow in the absence of any other signs or symptoms of peritonitis.  Confirmation rests on positive Sudan black stains of the supernatant for fat, and dialysate triglyceride levels exceeding plasma triglyceride concentrations.  Therapy consists of elimination of the causative condition, temporary cessation of PD, temporary bowel rest, and/or a diet of medium-chains fatty acids(1,4,5).

References

  1. Cheung CK, Khwaja A. Chylous ascites: an unusual complication of peritoneal dialysis. A case report and literature review. Perit Dial Int. 2008;28(3):229-231. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18474912.
  2. Melnick JZ, McCarty CM, Hunchik MP, Alexander SR. Chylous ascites complicating neonatal peritoneal dialysis. Pediatr Nephrol. 1995;9(6):753-755. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8747121.
  3. Huang CH, Chen HS, Chen YM, Tsai TJ. Fibroadhesive form of tuberculous peritonitis: chyloperitoneum in a patient undergoing automated peritoneal dialysis. Nephron. 1996;72(4):708-711. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8730450.
  4. Tsao Y-T, Chen W-L. Calcium channel blocker-induced chylous ascites in peritoneal dialysis. Kidney Int. 2009;75(8):868. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19337227.
  5. Saka Y, Tachi H, Sakurai H, Tawada M, Sawai A, Shimamura Y, Mizuno M, Maruyama S, Matsuo S, Ito Y. Aliskiren-induced chyloperitoneum in a patient on peritoneal dialysis. Perit Dial Int. 2012;32(1):111-113. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3525370&tool=p….
  6. Yamamoto T, Matsuda J, Kadoya H, Namba T, Takeji M, Yamauchi A. Azelnidipine-induced chyloperitoneum in a patient with microscopic polyangiitis. Clin Exp Nephrol. 2010;14(5):496-500. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20556459.
  7. Levy RI, Wenk RE. Chyloperitoneum in a peritoneal dialysis patient. Am J Kidney Dis. 2001;38(3):E12. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11532714.

The information and reference materials contained in this document are intended solely for the general education of the reader. It is intended to provide pertinent data to assist you in forming your own conclusions and making decisions. This document should not be considered an endorsement of the information provided nor is it intended for treatment purposes and is not a substitute for professional evaluation and diagnosis. Additionally, this information is not intended to advocate any indication, dosage or other claim that is not covered, if applicable, in the FDA-approved label.

P/N 102500-01 Rev. A 06/2016