Chylous ascites: an unusual case

A 70-year-old man presented with 6 weeks' history of increasing abdominal distension and shortness of breath. He was completely independent before this admission. Relevant past medical history included a recent normal colonoscopy for altered bowel habit. Although abstinent for 1 year, his alcohol consumption had been up to 100 units/week for over 50 years. He was on no medications and had never smoked. Clinical examination revealed massive ascites. Bloods on admission showed a normal platelet count, mild anaemia, haemoglobin 11.4 g/dl and mild renal impairment, urea 10.4 mmol/litre and creatinine 140 umol/litre. Liver function tests and a full liver screen including hepatitis virus B and C, autoantibodies, alfa-fetoprotein and ferritin were normal. Ultrasound of the abdomen showed a nodular liver suggesting cirrhosis with widespread ascites. Chest X-ray was normal. Ascitic fluid aspiration revealed milky white ascitic fluid with a very high triglyceride content of 17.4 mmol/litre (normal <2.2 mmol/litre) ...