Milky Mesentery: Acute Abdomen with Chylous Ascites

Interrelation of cancers of unknown primary, chylous ascites, and cavernous mesenteric lymphangioma in a 57-year-old female patient: a case report

Cancers of unknown primary (CUPs) pose diagnostic and therapeutic challenges because of their aggressive nature and elusive identification through conventional diagnostic means. This case report presents a unique finding in a 57-year-old female patient who, alongside her CUP, developed a cavernous mesenteric lymphangioma-a rare lymphatic malformation that is more commonly observed in pediatric populations. The interrelation between CUPs, chylous ascites, and lymphangiomas is explored, shedding light on this uncommon occurrence. Our patient's journey began with a CUP diagnosis, marked by metastatic adenocarcinoma. Subsequent symptoms led to the discovery of a mesenteric lymphangioma. The case unfolds the patient's diagnostic challenges, surgical interventions, and postoperative course. By highlighting the distinctive features of our case, we aim to contribute to the limited understanding of the interplay between lymphatic malformations and metastatic malignancies.

Rare Combination of Chyloperitoneum Secondary to Primary Small-Bowel Volvulus

Chylous ascites is the exudation from lymphatic content to the peritoneum and is a rare situation that mostly occurs following medical causes like neoplasms or cirrhosis. However, trauma to the lymphatic system due to compression by masses or altered anatomy can be a trigger too. We describe a rare combination of a primary small bowel volvulus in a young healthy adult causing chylous ascites. Obstruction caused by a primary small bowell volvulus can re-arrange the lymphatics anatomy increasing their flow pressure which can lead to rupture and leak. This is an emergent scenario that needs to be addressed quickly because of bowel ischaemia. CT scan is the gold standard to expedite diagnosis and go to surgical treatment. Although it can be an impactful finding, treatment of the cause behind chylous ascites results in complete resolution without any bowel resection.