Inflammatory processes associated with chylous ascites: A case report

Abstract

Chylous ascites is a rare form of ascites characterized by the accumulation of milky peritoneal fluid rich in triglycerides, with levels exceeding 200 mg/dL. Its origin is often related to obstruction rupture of lymphatic vessels, with malignancy being the most common cause, followed by liver cirrhosis. The latter is associated with chronic inflammatory processes mediated by cytokines and endothelial growth factors that promote lymphangiogenesis, initially a compensatory mechanism for lymphatic drainage. However, dysfunction of this mechanism can result in lymph leakage into the peritoneal cavity. This article reports the case of a patient with liver cirrhosis, on the transplant waiting list, presenting with long-standing ascites and a recent episode of spontaneous bacterial peritonitis, in whom chylous ascites was documented during hospitalization. The discussion addresses both mechanical factors (portal hypertension, increased lymphatic pressure) and molecular factors, including macrophage activation and the expression of lymphangiogenic genes induced by proinflammatory cytokines. The aim of this article is to present a case report of a rare clinical condition in the medical literature and, based on its analysis, to propose how inflammatory processes may contribute to the development of pathological lymphangiogenesis and lymphatic rupture. The article concludes that translational studies are needed to further elucidate these mechanisms.