Successful Treatment of Cirrhotic Chylous Ascites using Orlistat and Dietary Modifications: A Case Study and Literature Review

Patient: Male, 59-year-old Final Diagnosis: Chylous ascites Symptoms: Ascites • hepatorenal syndrome Clinical Procedure: — Specialty: General and Internal Medicine • Pharmacology and Pharmacy OBJECTIVE: Rare disease BACKGROUND: Chylous ascites (chyloperitoneum), a condition arising from lymphatic leakage in the peritoneal cavity, is rare in liver cirrhosis patients, accounting for less than 1% of cases. Treatment typically involves therapeutic paracentesis, dietary modifications, a low-fat, high-protein diet, and medium-chain triglyceride (MCT) supplementation. Orlistat, a fat absorption inhibitor, has been reported to show potential efficacy in treating chylous ascites. CASE REPORT: We detail the case of a 59-year-old male patient admitted for decompensated liver disease and worsening ascites. Diagnostic paracentesis identified chylous ascites, indicated by a 3.5 mmol/L triglyceride level. Despite administering therapeutic paracentesis, dietary modifications, MCT supplementation, Spironolactone, and Terlipressin for a presumed hepatorenal syndrome, the patient’ ascites remained chylous for two weeks. On administering orlistat, a significant reduction in ascites volume and chylous content was observed, with triglyceride levels dropping to 0.7 mmol/L. CONCLUSIONS: Our case demonstrates the potential role of orlistat in treating chylous ascites in liver cirrhosis. To the best of our knowledge, this is the second case reported in the literature to show a potential therapeutic role of orlistat in chylous ascites and could open the door for further exploration of orlistat’s benefit in such patients.