Use of orlistat (xenical) to treat chylous ascites.
Chylous ascites is uncommon and occurs in about 1 in 20,000 hospital admissions. Causes include disruption of the lymphatic system due to malignancy, cirrhosis, surgery, or radiation therapy. The mainstay of therapy has been low-fat diet supplemented with medium-chain triglyceride oil. However, dietary compliance can be difficult to achieve for adequate response. We report a 47-year-old man with hepatitis C and alcohol-related cirrhosis with new-onset chylous ascites and chylothorax. His ascites triglyceride was 585 mg/dL, and the pleural fluid triglyceride was 691 mg/dL. Ascitic and pleural fluid cytology and acid-fast bacilli stain were negative. The patient was treated with low-fat diet and medium-chain triglyceride oil. However, his ascites remained chylous after 1 week of treatment because of poor compliance with the dietary restrictions. Orlistat was then added to his treatment regimen. A half week later, the chylous component of his ascites resolved. Remaining high-volume clear ascites was treated with placement of a transjugular intrahepatic portosystemic shunt. To our knowledge, orlistat has never been used in the treatment of chylous ascites. This case suggests the potential value of adding orlistat to low-fat diet and medium-chain triglyceride oil in the treatment of chylous ascites, especially in patients who are unable to comply with the dietary restrictions.
Chen
Jaime
J
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of California, San Diego, CA 92161, USA.
Lin
Robert K
RK
Hassanein
Tarek
T
D002915:Chylous Ascites / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D003131:Combined Modality Therapy; D018752:Diet, Fat-Restricted; D006801:Humans; D007783:Lactones / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D000077403:Orlistat; D010349:Patient Compliance; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood*
D007783:Lactones; D014280:Triglycerides; D000077403:Orlistat