Diagnostic Dilemma


A 6 months old boy presented with abdominal distension for 5 days. On examination, he had ascites with hepatomegaly and weight of 5 kg. At birth, he developed hypoglycemic convulsions on Day 4 of life and was treated for neonatal sepsis. He had an NICU stay for 27 days. Birth weight was 2.18 kg. There was no umbilical catheterization or jaundice. He was on exclusive breast feeding. He had delayed development and had achieved only social smile and head holding till date. Ultrasound abdomen with colour doppler showed mild hepatomegaly with coarse echotexture and ascites. Hepatic veins and inferior vena cava were normal. Bilirubin was 0.6 mg, dl, SGOT = 79 IU, L, SGPT = 39 IU, L, total protein = 3.4 gm, dl, Albumin = 1.7 gm, dl with alkaline phosphatase of 373 IU, L. Prothrombin time {PT} and partial thromboplastin time {PTT} were normal. CT angiography showed normal hepatic veins and inferior vena cava. Ascitic tap showed chylous ascites with ascitic fluid Albumin of 0.85 gm, dl, cholesterol of 18.92 mg, dl, triglycerides of 202 mg, dl. Cytospin of ascitic fluid showed no malignant cells and there were no acid fast bacilli on smear. Serum cholesterol was 69 mg, dl with serum triglycerides of 85 mg, dl. Lymphangiogram was normal. He was treated with aldactone and a high protein diet to which his ascites decreased.

What is the cause of chylous ascites in this child_?
Answer Discussion :
doaa ibrahim
biliary obstruction
8 years ago
George Kateregga
Severe malnutrition
8 years ago

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