Abstract
A 73-year-old man complained of a sense of abdominal fullness and found to have large amounts of ascites at another hospital was referred to the hospital. Diagnostic puncture of the abdomen detected chylous ascites, and an abdominal CT scan revealed a shadow of a tumor with the diameter of about 5 cm, which was accompanied by calcification, in the mesentery located ventrally to the abdominal aorta. Malignant tumor or tuberculosis was suspected to be the causative disease for the chylous ascites, but no definite identification could be made by close systemic inspection or laparoscopic biopsy. Since the ascites fluid did not tend to decrease, a laparotomy was performed for diagnosis and treatment. Surgical findings showed not only chylous ascites but also edema and lymphatic congestion in the intestine; the lesion started at about 80 cm distant from the Treitz's ligament and extended for about 210 cm to the anal. The mesentery in this region was sclerotic and shortened, and the tumor with calcification was located centrally. It was suggested that the mesenteric lymphatic vessels were occluded by this tumor and consequently ruptured to develop chylous ascites. Dissection of the edematous intestine resulted in disappearance of the chylous ascites. Histopathological examination gave the definite diagnosis of mesenteric panniculitis.
