Chylous ascites: A rare initial presentation of pancreatic carcinoma

Abstract

Chylous ascites as first manifestation of pancreatic carcinoma is very rare. Usual presentations of pancreatic malignancy are abdominal discomfort, back pain, obstructive jaundice and duodenal obstruction. Development of chylous ascites during the course of the disease signifies poor prognosis. Malignancy and tuberculosis are the most common causes of this condition in developed and developing countries, respectively. Diagnosis is made on elevated triglyceride levels in ascitic fluid examination. Management is directed towards the treatment of primary cause and the chylous ascites. High protein and medium chain triglyceride diet is usually advised along with Orlistat for managing this condition. Peritoneovenus shunting can also be done but at the risk of complications. Our patient developed chylous ascites early in the course of the pancreatic carcinoma. CT scan abdomen was non-conclusive and cervical lymph node biopsy later on revealed that the primary disease was occult pancreatic carcinoma.