Chylous Ascites (Chyloperitoneum) as an Initial Sign of Gastric Carcinoma

Abstract

Chylous ascites is a rare clinical condition, characterized by ascites of a milky aspect and an ascitic concentration of triglycerides higher than 1000 mg/dl, or 2 to 8 times higher than in serum. We report a case of a 68 year-old male who presented with a 10kg weight loss and abdominal distention. Ascitic fluid was chylous, with triglycerides of 890 mg/dl (triglycerides in serum – 59 mg/dl). An abdominal CT scan revealed ascites and signs of chronic hepatic failure. An upper gastrointestinal endoscopy showed an invasive tumor in antrum. Gastric biopsy was diagnostic of a poorly differentiated adenocarcinoma. In conclusion, gastric adenocarcinoma should be included in differential diagnoses of chylous ascites in adults, together with lymphomas and other malignancies.