Finding of Chylous Ascites Secondary to Mesenteric Compression Due to Giant Inguinal Hernia: Tapp Approach

Aim Chylous ascites is an infrequent pathology with an incidence of less than 1%. We present the case of a patient with chylous ascites in the context of mesenteric compression due to a giant right inguinal hernia. Material and Methods We present the case of a 74-year-old woman with a personal history of a heart transplant in 2004 due to cardiomyopathy and a right inguinal hernia that had been going on for years. A CT scan identifies “Right inguinal hernia containing sigmoid and distal ileum”. Results During the surgical intervention, a giant right inguinal hernia was reduced with abundant chylous ascites, probably secondary to mesenteric compression. The patient was discharged on the 1st postoperative day without complications, with dietary recommendations. In the 1st month review, no signs of recurrence or seroma were identified. Conclussions Chylous ascites is defined as the presence of more than 200 mg/dl of triglycerides in the ascitic fluid. In adults, the most frequent causes are due to cirrhosis and malignant diseases. Another less common cause is post-surgical and traumatic, such as the case we describe, where we relate mesenteric compression and torsion to the development of chylous ascites. The gold standard imaging test is lymphoscintigraphy. The definitive diagnosis is obtained through evacuative paracentesis. Management is based on the combination of a diet rich in protein and low in fat, with medium chain triglycerides. In refractory cases, drugs such as Octreotide and Somatostatin can be used. Surgery should be used as a last measure.