Chylous Ascites From Cirrhosis-Related Portal Hypertension Treated With Medium-Chain Triglycerides, Octreotide, and Paracentesis

Chylous ascites is a rare complication of cirrhosis-related portal hypertension, accounting for less than 1% of ascites cases. We report a 76-year-old diabetic woman with prior breast cancer and cirrhosis secondary to metabolic dysfunction-associated fatty liver disease presenting with abdominal distension, bloating, and dyspnea. Paracentesis revealed pink milky chylous fluid with triglycerides of 269 mg/dL. Malignancy was excluded by cytology and positron emission tomography-computed tomography. Treatment with a medium-chain triglyceride diet, fat-soluble vitamins, diuretics with albumin, octreotide (200 μg/d), and paracentesis led to clinical improvement. This case underscores the rarity of chylous ascites and the efficacy of multimodal conservative management.