3. Discussion
There are a lot of causes of chylous ascites. The most common causes are abdominal malignancy and cirrhosis. Other causes are infectious, congenital, inflammatory, postoperative, traumatic, and miscellaneous disorders including right heart failure, dilated cardiomyopathy, and nephrotic syndrome. The pathogenesis of chylous ascites in nephrotic syndrome remains unclear. Lindenbaum and Scheidt explained that hypoalbuminemia led to edema of the mucosa and submucosa in intestinal structures [1]. The change that increases the permeability of mucosal cells, submucosal lymphatics, or serosal lymphatics results in the leakage of chylomicrons into the peritoneal space [1].
Detection of chylous ascites can be readily made with simple tests and radiological images. The triglyceride levels in ascites are very important in defining chylous ascites and typically above 200 mg/dL [2]. Lipoprotein electrophoresis in chylous peritoneal fluid can be performed to show the presence of predominant chylomicrons. Computed tomography of abdomen is suggested to identify pathological intra-abdominal lymph nodes and masses. Other kinds of radiological studies such as lymphangiography and lymphoscintigraphy are recommended in evaluating abnormal retroperitoneal nodes, leakage from dilated lymphatics, fistulization, and obstruction of the thoracic duct. These radiological images may select patients who are candidates for surgical intervention [2].
In conclusion, chyloperitoneum associated with nephrotic syndrome is very rare disorder [3–5]. Lipoprotein electrophoresis is useful for confirmation of the diagnosis with chyloperitoneum. Minimal change nephrotic syndrome in the adults is characterized by a good response to corticosteroid. Treating underlying disease is the most importance in the management of these patients.