# Chyloperitoneum in a toddler on peritoneal dialysis

## TL;DR

A toddler on peritoneal dialysis developed chyloperitoneum, which was linked to an abdominal tumor and resolved with chemotherapy and dietary changes.

## Contribution

This case highlights the importance of investigating chyloperitoneum in pediatric PD patients for underlying malignancies.

## Key findings

- Chyloperitoneum in a toddler on PD was caused by multifocal hepatoblastoma.
- Chemotherapy and a medium chain triglycerides diet resolved the chyloperitoneum.
- Pediatric PD patients with chyloperitoneum may require thorough abdominal evaluation for malignancies.

## Abstract

Chyloperitoneum is an uncommon diagnosis in peritoneal dialysis (PD) patients. While admitted for emesis and feeding intolerance, a 16-month-old male on PD developed milky-colored dialysate with increased triglycerides, indicating chyloperitoneum. In adult PD patients, chyloperitoneum can indicate potentially life-threatening pathologies including malignancies and liver or heart disease. By contrast, pediatric patients on PD with chyloperitoneum had recently undergone PD catheter or gastrostomy tube placement with presumed disruption of abdominal lymphatics. Slowing lymph flow through dietary manipulation and rarely, temporary withholding of PD, resolved chyloperitoneum. We report a toddler on PD with chyloperitoneum in whom abdominal investigation showed multifocal hepatoblastoma. Chemotherapy and a medium chain triglycerides (MCTs)-based diet led to prompt resolution of chyloperitoneum. Intrabdominal malignancy in this patient illustrates the importance of a prompt, thorough evaluation of chyloperitoneum to allow definitive therapy if required.