Chylous ascites is an uncommon clinical condition characterized by extravasation of milky chyle into the peritoneal cavity usually as a result of either blockage of the lymphatics or leakage from inadvertent trauma during surgeries. This is a report of a case of chylous ascites in a 32-year old Nigerian with HIV/TB co-infections. The report also highlights the challenges associated with management of chylous ascites in a resource-poor setting. The patient was managed conservatively with diuretic therapy, salt and fluid restrictions and elevation of the lower limbs. Although, the ascites re-accumulated initially, it finally resolved and she was followed up for at least six months with no recurrence.

Keywords: Chylous ascites, HIV/TB co-infections, resource-poor settings, management challenges.

1. Chaisson RE, Marinson NA. Tuberculosis in Africa-combating an HIV-driven crisis. N Eng J Med 2008; 358: 1089-1092
2. Leeds IL, Magee MJ, Kurbatova EV, et al. Site of Extrapulmonary Tuberculosis is Associated with HIV Infection. Clin Infect Dis 2012; 55:75
3. von Reyn CF, Kimambo S, Mtei L, Arbeit RD, Maro I, Bakari M, Matee M, Lahey T. Disseminated tuberculosis in human immunodeficiency virus infection: ineffective immunity, polyclonal disease and high mortality. Int J Tuberc Lung Dis 2011; 15:1087-1092
4. Talluri SK, Nuthakki H, Tadakamalla A, Talluri J, Besur S. Chylous ascites. North Am J Med Sci 2011; 3(9): 438-440
5. Shan SS, Ahmed K, Smith R, Mallina R, Akhbari P, Khan MS. Chylous ascites in a TB/HIV co-infected patient: case report and literature review. Journal of Medical Case Report 2008; 2: 3 doi: 10.1186/1752-1947-2-3. Available at http://www.jmedicalcasereports.com/contents/2/1/3
6. Lin J, Lai C, Chen Y, Chang L, Lee SS, Lin H. Immune reconstitution inflamma-tory syndrome presenting as chylothorax in a patient with HIV and Mycobacterium tuberculosis coinfection. BMC Infectious Diseases 2010, 10: 321. Available at http://www.biomedcentral.com/1471-2334/10/321
7. Summachiwakij S, Tungsubutra W, Koomanachai P, Charoenratanakul S. Chylous ascites and chylothorax due to constrictive pericarditis in a patient infected with HIV: a case report. Journal of Medical Case Reports 2012, 6: 163. Available at http://www.jmedicalcasereports.com/contents/6/1/163
8. Savage MP, Muñoz SJ, Herman WM, Kusiak VM: Chylous ascites caused by constrictive pericarditis.Am J Gastroenterol 1987, 82:1088-1090
9. Guneri S, Nazli C, Kinay O, Kirimli O, Mermut C, Hazan E: Chylous ascites due to constrictive pericarditis.Int J Card Imaging 2000, 16:49-54
10. Guneri S, Nazli C, Kinay O, Kirimli O, Mermut C, Hazan E. Chylous ascites due to constrictive pericarditis. Int Card Imaging 2000, 16: 49-54
11. Williams AT, Schneider RP: Chylous ascites should suggest constrictive pericarditis even in a patient with cirrhosis. J ClinGastroenterol 1990, 12:581-584
12. Villena V, de Pablo A, Martin-Escribano P: Chylothorax and chylous ascites due to heart failure.EurRespir J 1995, 8:1235-1236
13. Hurley MK, Emiliani VJ, Comer GM, Patel A, Navarro C, Maiki CO: Dilated cardiomyopathy associated with chylous ascites.Am J Gastroenterol 1989, 84:1567-1569
14. Press OW, Press NO, Kaufman SD. Evaluation and management of chylous ascites. Ann Intern Med 1982; 96(3): 358-364
15. Llan I, Yoram M, Jacob G, Jacob R. The diagnosis and management of postoperative chylous ascites: review article. J Urol 2002; 167: 449-457
16. Ijichi H, Soejima Y, Taketomi A, Yoshizumi T, Uchiyama H, Harada N, et al. Successful management of chylous ascites after living donor liver transplantation with somatostatin. Liver Int 2008; 28 (1): 143-145
17. Baran M, Cakir M, Yuksekkaya HA, Arikan C, Aydin U, Aydogdu S, et al. Chylous ascites after living related liver transplantation treated with somatostatin analogue and parenteral nutrition. Transplant Proc 2008; 40(1): 320-321
18. Chen J, Lin RK, Hassanein T. Use of orlistat (xenical) to treat chylous ascites. J ClinGastroenterol 2005; 39(9): 831-833
19. Berzigotti A, Magalotti D, Cocci C, Angeloni L, Pironi L, Zoli M. Octreotide in the outpatient therapy of cirrhotic chylous ascites: a case report. Dig Liver Dis 2006; 38(2): 138-142
20. Zeidan S, Delarue A, Rome A, Roquelaure B. Fibrin glue application in the management of refractory chylous ascites in children. J Paediatr Gastroenterol Nutr Apr 2008; 46(4): 478-481
21. Matsufuji H, Nishio T, Hosoya R. Successful treatment for intractable chylous ascites in a child using a peritoneovenous shunt. PaediatrSurgInt 2006; 22(5): 471-473
22. De Vries GJ, Ryan BM, de Bievre M et al. Cirrhosis related ascites successfully treated with TIPS. Euro J Gastroenterol Hepatol 2005;17(4): 463-466.

Olusegun Adesola Busari

Department of Internal Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria

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