A case report on post radiotherapy chylous ascites treated with “fasting + octreotide”

Rationale: Chyloascites is a rare disease characterized by the compression and obstruction of the thoracic duct, abdominal lymphatic vessels, and their branches, or the leakage of chyle into the abdominal cavity after trauma. The treatment includes dietary adjustments, therapeutic puncture, medication therapy, surgical treatment, etc. Patient concerns: We present a detailed case of a 55-year-old male patient admitted to the hospital due to abdominal distension. Diagnoses: Diagnosis was confirmed by paracentesis, which revealed milky-appearing ascitic fluid with a markedly elevated triglyceride level of 264 mg/dL, consistent with chylous ascites. Interventions: To alleviate the symptoms of ascites, we adopted methods such as peritoneal puncture drainage, diuretics, fasting, and subcutaneous injection of octreotide. Outcomes: Initial treatments such as paracentesis and diuretics were ineffective. However, following a combination of fasting, parenteral nutrition, and subcutaneous octreotide injection, a significant reduction in ascites was observed, with the ascites transitioning from milky to clear. Lessons: This case demonstrates the potential efficacy of the combined treatment of fasting, parenteral nutrition, and octreotide in managing chylous ascites.