J Korean Med Sci.  2007 Sep;22(Suppl):S164-S166. 10.3346/jkms.2007.22.S.S164.

Acute Chylous Peritonitis Mimicking Ovarian Torsion in a Patient with Advanced Gastric Carcinoma

• Kang CM
• Kim S
• Kim BW
• Kim KS
• Choi JS
• Lee WJ
• Kim BR

• KMID: 1785808
• DOI: http://doi.org/10.3346/jkms.2007.22.S.S164

Abstract

The extravasation of chyle into the peritoneal space usually does not accompany an abrupt onset of abdominal pain with symptoms and signs of peritonitis. The rarity of this condition fails to reach preoperative diagnosis prior to laparotomy. Here, we introduce a case of chylous ascites that presented with acute abdominal pain mimicking peritonitis caused by ovarian torsion in a 41-yr-old female patient with advanced gastric carcinoma. An emergency exploratory laparotomy was performed but revealed no evidence of ovarian torsion. Only chylous ascites was discovered in the operative field. She underwent a complete abdominal hysterectomy and salphingo-oophorectomy. Only saline irrigation and suction-up were performed for the chylous ascites. The postoperative course was uneventful. Her bowel movement was restored within 1 week. She was allowed only a fat-free diet, and no evidence of re-occurrence of ascites was noted on clinical observation. She now remains under consideration for additional chemotherapy.

Keyword

Chylous Peritonitis; Ovarian Torsion; Advanced Gastric Carcinoma

MeSH Terms

Abdomen, Acute/etiology
Adult
Chylous Ascites/*diagnosis/*etiology
Diagnosis, Differential
Female
Humans
Ovarian Diseases/*diagnosis
Stomach Neoplasms/*complications
Torsion Abnormality/*diagnosis

Figure

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  Fig. 1 Abdominal pelvic CT scan. A large ovarian tumor with a minimal fluid collection was noted.

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  Fig. 2 Milky fluid discharged from small bowel mesentery.

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  Fig. 3 Retroperitoneal whitish fluid staining around the ascending colon.

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