A Case of Chylous Ascites Accompanied with Volvulus with Malrotation

Abstract

A 16-year-old man without past medical history presented with upper abdominal pain after lunch. He was suspected to have strangulated ileus by an abdominal ultrasound and was transferred to our hospital on the same day. An abdominal CT scan showed a SMV rotation sign, a whirlpool sign, ascites and a branch of superior mesenteric artery to be twisted counterclockwise by 180 degree. We diagnosed the case as a midgut volvulus with malrotation. Our observation with a laparoscope revealed chylous ascites and midgut volvulus without intestinal necrosis. We repositioned the intestine and performed appendectomy without bowel resection. He was discharged from our hospital on the 19^th postoperative day, though he was associated with postoperative paralytic ileus.

We should try to check whether ascites is chylous or not and consider a necessary and sufficient treatment while keeping the fact in mind that a twisted intestine can be conserved in all cases of intestinal volvulus with chylous ascites.