Primary chylous peritonitis: a rare case report from Syria

Abstract

Introduction and importance: Chylous peritonitis is characterized by a sudden accumulation of chyle in the peritoneal cavity, leading to symptoms of an acute abdomen. This condition is quite rare, with less than 100 cases documented in the medical literature, and is often misdiagnosed. Case presentation: The authors present a case of an acute abdomen in a young man who was initially suspected to have a perforated peptic ulcer. After laparotomy, the diagnosis of chylous peritonitis was confirmed. Despite extensive investigations, no underlying cause was identified. Treatment involved peritoneal lavage and placement of a pelvic drainage tube, with discharge after three days on a low-fat. Clinical discussion: Chylous peritonitis is a relatively rare condition, occurring in ~1 in 20 000 individuals. Chyle leakage can be detected through various diagnostic modalities including ultrasound, computed tomography, laparoscopy, or exploratory laparotomy. In cases where a definitive etiology is not identified, treatment typically involves peritoneal lavage and drainage. Postoperative management focuses on a low-fat diet and somatostatin administration to prevent recurrence. Conclusion: The present case highlights the importance of considering primary chylous peritonitis as a potential cause of acute abdomen in young patients. Future research should focus on identifying risk factors and establishing evidence-based guidelines for approaching this condition.