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The cisterna chyli is an important structure because it receives the lymphatic drainage from the intestinal trunk, the right and left lumbar lymphatic trunks, and small lymph vessels that descend from the lower part of the thorax. Injury to the cisterna chyli is rare and eventful. It may manifest with chylous ascites and chyloretroperitoneum (1, 2).
Chylous ascites is the accumulation of a milk-like peritoneal fluid that is rich in triglycerides, due to the presence of thoracic or intestinal lymph in the abdominal cavity. It develops when there is a disruption of the lymphatic system due to traumatic injury or obstruction (from benign or malignant causes) (3).
Many pathological conditions can result in chylous ascites. These conditions include congenital defects of the lymphatic system; nonspecific bacterial, parasitic, and tuberculous peritoneal infections; liver cirrhosis; malignant neoplasm; surgical injury; and blunt abdominal trauma. However, the most common cause in adults is believed to be abdominal malignancy, while congenital lymphatic abnormalities is the most common cause in the pediatric population. The incidence of chylous ascites seems to be increasing because of more aggressive thoracic and retroperitoneal surgeries and with the prolonged survival of patients with cancer (4). Examples for surgical procedures that may be associated with chylous ascites are abdominal aortic aneurysm repair, retroperitoneal lymph node dissection, pancreaticoduodenectomy, liver transplantation, catheter placement for peritoneal dialysis, distal splenorenal shunt, inferior vena cava resection, and laparoscopic Nissen fundoplication (3).
Progressive and painless abdominal distention is the major clinical manifestation of chylous ascites, which occurs over the course of weeks to months, depending upon the underlying cause. Acute onset of symptoms may be observed in patients who have undergone either an abdominal or thoracic surgical intervention or had a major traumatic injury.
Blunt abdominal trauma resulting in intestinal and mesenteric injury is also another important cause of chylous ascites (1). However, cases of chylous injury without any affected adjacent structure or organs after blunt abdominal trauma are rarely reported in the literature.
We herein report a case of isolated chylous rupture due to blunt abdominal trauma with manifestations of both chylous ascites and chyloretroperitoneum.
Case Presentation
A 54-year-old man was involved in a deceleration-type traffic accident when he was in the passenger seat of an automobile with his seat belt strapped...