Chylous Ascites: A Sign of Unsuspected Child Abuse

Abstract

Chylous fluid accumulation in the peritoneal cavity is associated with pathology in the lymphatic system. Primary (congenital) chylous ascites develops during the first year of life, while secondary (acquired) chylous ascites, resulting from lymphatic obstruction or trauma, can arise at any time during life. Both lead to spillage of chyle into the peritoneal cavity from ruptured lacteals and lymphatic ducts. Radiographic findings suggestive of intentional injury have been observed in most published cases of secondary chylous ascites resulting from child abuse.1-4 We present a child with chylous ascites who was initially thought to have lymphangiectasia but who was later found to be a victim of abuse.