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Symptomatic Enterocele

An Unusual Presentation of Chylous Ascites and Lymphoma

From the ¹Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Women and Infants’ Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island.

ABSTRACT

BACKGROUND: Chylous ascites is a rare phenomenon caused by extravasation of chyle from the lymphatic system. In Western countries, the majority of adult cases are due to occlusion of the lymphatics secondary to a lymphoma or other malignancy.

CASE: A middle-aged woman with reports of fecal urgency, incomplete bowel evacuation, and recurrent pelvic organ prolapse presented for surgical correction of a posterior vaginal defect. During the repair, a sac filled with milky white fluid was found ventral to the rectum. Further dissection revealed a large enterocele filled with chylous ascites. Postoperatively, diffuse lymphadenopathy was detected by computed tomography imaging, and a biopsy confirmed follicular lymphoma.

CONCLUSION: Repair of symptomatic pelvic organ prolapse revealed underlying chylous ascites and lymphoma. Ascites may have exacerbated underlying support defects in the pelvic floor.