A 3-year-old girl with recurrent
chylous ascites was successfully treated by laparoscopic
ligation of the ruptured lymphatic trunk. She was referred to our hospital at 16 days of age because of marked abdominal distension. Imaging methods showed massive
ascites of unknown origin, and analysis of the
ascites revealed its chylous nature.
Conservative treatments were started. Her condition improved to some extent, and she was discharged. Two years later, she was readmitted with abdominal distension and loss of appetite. Laparoscopic surgery was planned to clarify the etiology and to treat intractable
ascites.
Sudan black B was orally administered, and laparoscopy revealed the presence of a whitish-gray fluid in the abdominal cavity, and a dark-blue stream of the
dye was noticed. The responsible lesion of the
chylous ascites was detected by tracking the stream. The lesion was ligated twice with an endoloop. She has been completely free from the symptoms for 3 years and 9 months. This experience indicates the usefulness of laparoscopic surgery in investigating the etiology of
chylous ascites and treating it. The concomitant use of a lipophilic
dye is mandatory to find the responsible lesion at surgery. Laparoscopic surgery, instead of open surgery, should be considered as a treatment of choice for intractable
chylous ascites.