Perinatology.  2017 Jun;28(2):69-73. 10.14734/PN.2017.28.2.69.

Ileal Atresia Presenting with Massive Chylous Ascites and Hydrocele in a Newborn

• Kim J
• Hong YJ
• Cho HH
• Shim SY
• Park EA
• Cho SJ

• KMID: 2386355
• DOI: http://doi.org/10.14734/PN.2017.28.2.69

Abstract

We report a case of ileal atresia presenting with massive chylous ascites and hydrocele in a neonate. A male neonate was born at 38 weeks of gestation with a weight of 3,360 grams. The antenatal ultrasonography performed at 37⁺⁶ weeks of gestation showed ascites and huge bilateral hydrocele. At birth, he manifested hypotonia, a massively distended abdomen and huge bilateral hydrocele. Exploratory laparotomy was performed on the day of birth. A large amount of chyle (approximately 200 mL) was found in the peritoneal cavity between the bowel loops. An additional 120 mL of chyle was removed from both scrotal sacs. The color of chyle was ivory yellow with whitish debris. Ileal atresia had occurred 7 cm above the ileocecal valve. The proximal small bowel was disconnected, and the distal small bowel loop ended in a blind loop. Lymphatic drainage from that cross section of the proximal small bowel might be a cause of chylous ascites. Segmental small bowel resection and double barrel ileostomy was performed. We described this case with a review of the literature.

Keyword

Intestinal atresia; Ascites; Chyle; Newborns

MeSH Terms

Abdomen
Ascites
Chyle
Chylous Ascites*
Drainage
Humans
Ileocecal Valve
Ileostomy
Infant, Newborn*
Intestinal Atresia
Laparotomy
Male
Muscle Hypotonia
Parturition
Peritoneal Cavity
Pregnancy
Ultrasonography

Figure

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  Fig. 1 The ascites depth of 2.3 cm was detected by antenatal ultrasonography.

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  Fig. 2 At birth, the patient showed a massively distended abdomen and huge bilateral hydrocele.

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  Fig. 3 On the abdomen x-ray, the bowel gas was located centrally.

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  Fig. 4 In the ultrasonography, large amount of ascites and thickening of the small bowel loop were seen.

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  Fig. 5 The proximal small bowel was disconnected, and the distal small bowel ended in a blind loop.

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  Fig. 6 Few necrotic tissues with scanty amount of viable small intestine wall were observed.

Reference

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