Intestinal malrotation causing chylous ascites in an adolescent: a case report

INTRODUCTION: Intestinal malrotation is a rare etiology of chylous ascites in adolescents. Chylous ascites is caused by lymphatic system disarrangement, which can result in an anomalous build-up of a lymphatic fluid rich in lipid, namely chyle in the peritoneal cavity. PRESENTATION OF CASE: We present a case of a 16-year-old Saudi Arabian male who came to the emergency department with right upper quadrant pain associated with difficulty in passing stool for one day and a history of congenital diaphragmatic hernia (CDH) repair at the age of 4 months. Free fluid in the abdomen was noticed in the bedside ultrasound. Abdominopelvic computed tomography revealed dilated small bowel loops and a whirl sign of the mesentery, which indicated intestinal torsion. The patient was treated using Ladd's procedure, and a large volume of chylous fluid was removed from the abdomen. Postoperatively, the abdominal drain revealed no chyle, and the patient was followed-up as an outpatient at which point, he reported no abdominal pain. DISCUSSION: Intestinal malrotation is more commonly reported in children and associated with congenital chylous ascites. Chylous ascites by itself is a rare occurrence, and very few cases attribute it to intestinal malrotation in adults. Surgical management with Ladd's procedure is a well-documented surgery in pediatric patients, and yet it was successfully performed in our adolescent patient. CONCLUSION: Surgical management of chylous ascites secondary to intestinal malrotation in an adolescent, which is considered novel in this age group, including peritoneal lavage of chyle, resulted in favorable outcomes. (C) 2020 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).