Chylous ascites as hernia content in a prematurely born infant with bilateral inguinal hernia

We present the case of an infant born at 29 6/7 weeks of gestational age, who underwent semi-elective surgical repair for bilateral inguinal hernia at four months of age. During surgery, chyle was unexpectedly found in the hernia sac and abdominal cavity. Chylous ascites is a rare condition in infants. Possible etiologic factors include (surgical) trauma, congenital lymphatic anomalies, infectious diseases, liver cirrhosis, cardiac failure, neoplasms and metabolic conditions. A thorough diagnostic workup for chylous ascites was performed to rule out pre-existent underlying pathologies, and the child was temporarily placed on a medium-chain triglyceride diet. An ultrasound after two weeks showed no recurrence of ascites and the child was successfully placed on regular formula feeding. No symptoms occurred afterwards. Based on the clinical course and results of additional investigations, this rare phenomenon has most likely occurred due to obstruction and potential rupture of lymphatic structures due to mechanical effects following intermittent incarceration and subsequent repetitive manual reduction of the symptomatic hernia including bowel loops as content of the hernia sac.