Chylous ascites refers to the accumulation of lipid-rich lymph in the peritoneal cavity due to disruption of the lymphatic system secondary to traumatic injury or obstruction. Worldwide, abdominal malignancy, cirrhosis, and tuberculosis are the commonest causes of CA in adults, the latter being most prevalent in developing countries, whereas congenital abnormalities of the lymphatic system and trauma are commonest in children. The presence of a milky, creamy appearing ascitic fluid with triglyceride content above 200？mg/dL is diagnostic, and, in the majority of cases, unless there is a strong suspicion of malignancy, further investigations are not required in patients with cirrhosis. If an underlying cause is identified, targeted therapy is possible, but most cases will be treated conservatively, with dietary support including high-protein and low-fat diets supplemented with medium-chain triglycerides, therapeutic paracentesis, total parenteral nutrition, and somatostatins. Rarely, resistant cases have been treated by transjugular intrahepatic portosystemic shunt, surgical exploration, or peritoneovenous shunt. 1. Introduction Chylous ascites (CA) is an uncommon form of ascites, defined as the leakage of the lipid-rich lymph into the peritoneal cavity [1]. Damage or obstruction to the lymphatic system or one of its tributaries produces ascites with a turbid or milky appearance from the high triglyceride content [1]. Asellius, in 1622, first described the lymphatic system in a dog after observing vessels in the mesentery containing a white milky fluid [2] and, in 1694, Morton reported the first case of CA in a 2-year-old boy who died with tuberculosis [2]. The reported incidence of CA is approximately 1 in 20,000 admissions at a large university-based hospital over 20-year period [3]. However, it is believed that the incidence has increased, probably because of prolonged survival of patients with cancer and more aggressive cardiothoracic and abdominal interventions as well as laparoscopic surgery and transplantation [2]. This trend is supported by the finding of a 1 per 11,589 incidence in the last years of the study [3]. The reported incidence would also probably greatly increase if paracentesis and an appropriate analysis of the ascitic fluid were performed with all patients with ascites [2]. The prognosis basically varies based on the underlying cause. In the same study, the 1-year mortality rate was 71%, which increased to 90% when a malignancy was the underlying cause. Other study that included a greater proportion of congenital or traumatic cases
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