Chylous Ascites From Cirrhosis-Related Portal Hypertension Treated With Medium-Chain Triglycerides, Octreotide, and Paracentesis

Chylous ascites is a rare complication of cirrhosis-related portal hypertension, accounting for less than 1% of ascites cases. We report a 76-year-old diabetic woman with prior breast cancer and cirrhosis secondary to metabolic dysfunction–associated fatty liver disease presenting with abdominal distension, bloating, and dyspnea. Paracentesis revealed pink milky chylous fluid with triglycerides of 269 mg/dL. Malignancy was excluded by cytology and positron emission tomography–computed tomography. Treatment with a medium-chain triglyceride diet, fat-soluble vitamins, diuretics with albumin, octreotide (200 μg/d), and paracentesis led to clinical improvement. This case underscores the rarity of chylous ascites and the efficacy of multimodal conservative management.