The first case of chyle ascites in childhood was reported by Morton in 1683. Its reported incidence varies between 1 in 50,000 to 100,000 in hospital admissions. The clinical picture is similar to that of acute diffuse peritonitis, and is most
commonly
mistaken as perforated appendicitis. Paracetesis, if performed, is the most useful diagnostic option. Treatment modalities fall into four areas-: Exploratory laparotomy with either direct ligation or drainage, A medium chain triglyceride diet, NPO
and
hyperalimentation or Venoperitoneal shunting. An 11-years old boy was admitted with RLQ pain. He had diffuse abdominal guarding. The initial diagnosis was perforated appendicitis, and appendectomy was performed. During the operation, the abdomen
was
found to contain 750㏄ of a thin, milky fluid. It was later diagnosed as chyle ascites. The small bowel mesentery and transverse colon were thickened and edematous, with a pale white subserosal exudate. The laboratory analysis of the ascites was
as
follows-: protein 4.6 g/㎗, albumin 3.0 g/㎗, triglyceride 700 ㎎/㎗, cholesterol 113 ㎎/㎗, glucose 209 ㎎/㎗, LDH 848 μ/ℓ, and amylase 32 μ/㎗, with a pH of 9.0. An appendectomy was performed, and two drains placed in the pelvic cavity. In
the
postoperative-work-up from the abdominal CT scan, the results were normal. The patient-recovered and was discharged without complication 21 days postoperatively.
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