Acute chylous peritonitis. Report of two cases and literature review

The extravasation of chyle into the peritoneal cavity is rarely associated with the sudden development of clinical signs and symptoms of peritonitis. Therefore, an acute abdomen due to acute chylous peritonitis is very rare in our clinical experience. A review of the literature indicates 63 cases of this unusual disorder have been documented. In the majority of cases, an underlying cause could not be demonstrated. We present two adult female patients who sought medical treatment at our emergency department for the acute onset of abdominal pain and tenderness. The attack was preceded briefly by a meal in one patient and a blunt abdominal trauma in the other. A marked peritoneal sign prompted urgent laparotomy. During the operation, a considerable amount of free, sterile, non-foul-smelling chylous fluid was found in the peritoneal cavity. The fluid seemed to come out from the accumulated chyle between the mesenteric leaves. After taking a few milliters of milky fluid and several pieces of lymph node for the diagnostic purpose. We performed a thorough irrigation of the whole abdomen and placement of drains. Both of the patients, as the majority of cases in the literature, recovered uneventfully without recurrence after two and a half years of follow-up. Therefore, this illness, can generally be considered to have a benign course and a good prognosis. However, we'd like to suggest that early awareness and appropriate treatment are still needed for the best out come.