Idiopathic Acute Chylous Peritonitis during pregnancy, mimic
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Acute chylous peritonitis is an extremely rare diagnosis, especially in pregnancy, previously described in the setting of pancreatitis but can masquerade as perforated appendicitis.
In early pregnancy there is a diagnostic dilemma and once other sources of sepsis are excluded a diagnostic laparoscopy should be considered. A medium fatty-chain acid diet with MCT oil supplementation and dietician input is crucial in management.

Chylous ascites (CA) are an extremely rare presentation in pregnancy and pose a diagnostic challenge in clinical practice. There have only been a few case reports of CA in pregnancy with the majority of cases found incidentally at the time of cesarean section or in the context of pancreatitis.

A 36-year-old female who was 13 weeks pregnant had clinically presented right iliac fossa pain with peritonitis and had signs of sepsis. Once the other potential sources of sepsis were excluded, had proceeded to diagnostic laparoscopy performed by the treating consultant given there were no appropriate out-of-hours imaging modalities available.

This case report hopes to advocate for the effective intervention of diagnostic laparoscopy in this setting and other important considerations for management during first-trimester pregnancy. Upon diagnosis, the patient was put onto a medium-chain fatty acid diet with excellent outcomes post-operatively and at the outpatient follow-up.

In particular, chylous ascites is a rare finding and additionally is even more rare to cause peritonism. What they found most interesting in this case is that in the absence of any other potential sources of infection, how chylous ascites not only presented with peritonism but prompted a septic response. Another pertinent issue is that in pregnancy doctors are limited with investigative options and therefore diagnosis will depend on the clinical presentation and the decision for prompt diagnostic/therapeutic laparoscopy should be strongly considered.

International Journal of Surgery Case Reports
Source: https://doi.org/10.1016/j.ijscr.2021.105790
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