천공성 충수돌기염으로 오인된 유미성 복수 1예
A Case of Chyle Ascites Mistaken as Perforated Appendicitis
배종대, 배정민, 정병욱, 정기훈, 배성한, 안우섭,
소속 상세정보
배종대 ( Bae Jong-Dae )
동국대학교 의과대학 외과학교실
배정민 ( Bae Jung-Min )
동국대학교 의과대학 외과학교실
정병욱 ( Jung Byeong-Wuk )
동국대학교 의과대학 외과학교실
정기훈 ( Jung Ki-Hoon )
동국대학교 의과대학 외과학교실
배성한 ( Bae Sung-Han )
동국대학교 의과대학 외과학교실
안우섭 ( Ahn Woo-Sup )
동국대학교 의과대학 외과학교실
KMID : 0371320020630010084
Abstract
The first case of chyle ascites in childhood was reported by Morton in 1683. Its reported incidence varies between 1 in 50,000 to 100,000 in hospital admissions. The clinical picture is similar to that of acute diffuse peritonitis, and is most
commonly
mistaken as perforated appendicitis. Paracetesis, if performed, is the most useful diagnostic option. Treatment modalities fall into four areas-: Exploratory laparotomy with either direct ligation or drainage, A medium chain triglyceride diet, NPO
and
hyperalimentation or Venoperitoneal shunting. An 11-years old boy was admitted with RLQ pain. He had diffuse abdominal guarding. The initial diagnosis was perforated appendicitis, and appendectomy was performed. During the operation, the abdomen
was
found to contain 750㏄ of a thin, milky fluid. It was later diagnosed as chyle ascites. The small bowel mesentery and transverse colon were thickened and edematous, with a pale white subserosal exudate. The laboratory analysis of the ascites was
as
follows-: protein 4.6 g/㎗, albumin 3.0 g/㎗, triglyceride 700 ㎎/㎗, cholesterol 113 ㎎/㎗, glucose 209 ㎎/㎗, LDH 848 μ/ℓ, and amylase 32 μ/㎗, with a pH of 9.0. An appendectomy was performed, and two drains placed in the pelvic cavity. In
the
postoperative-work-up from the abdominal CT scan, the results were normal. The patient-recovered and was discharged without complication 21 days postoperatively.
키워드
유미성 복수; 천공성 충수염; Chyle ascites; Perforated appendicitis;
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