Doctors reported an extremely unusual case where a pregnant woman carrying twins developed a rare condition called chylous ascites—a buildup of milky fluid in the abdomen. This happened only once before in medical records, making it a one-of-a-kind discovery. The 25-year-old woman experienced severe belly pain at 32 weeks and needed emergency surgery. Doctors found 2000 milliliters of milky fluid and successfully treated her with special diet changes and medication. She recovered completely and stayed healthy for three years afterward. This case helps doctors understand that this rare condition can happen in twin pregnancies and teaches them how to recognize and treat it.

The Quick Take

  • What they studied: A single case of a rare belly fluid buildup (chylous ascites) that happened in a woman pregnant with twins
  • Who participated: One 25-year-old woman who was healthy before pregnancy and carrying twin babies at 32 weeks of pregnancy
  • Key finding: The woman developed a rare condition with milky fluid in her abdomen, which was successfully treated with diet changes and medication, and she fully recovered
  • What it means for you: This case is extremely rare and unlikely to affect most pregnant women. However, it teaches doctors to consider this condition if a pregnant woman—especially one carrying twins—has unexplained belly pain and fluid buildup. If you’re pregnant and experience severe abdominal pain, contact your doctor immediately

The Research Details

This is a case report, which means doctors documented one specific patient’s medical story in detail. The 25-year-old woman came to the hospital at 32 weeks of pregnancy (about 7.5 months) with severe belly pain and nausea. Doctors performed emergency surgery and discovered 2000 milliliters (about 2 quarts) of unusual milky-white fluid in her abdomen. They tested this fluid and found it contained very high levels of fat (triglycerides), which confirmed the diagnosis of chylous ascites—a condition where lymphatic fluid (a clear fluid that normally drains through the body) leaks into the belly.

After surgery, the doctors treated the patient with three main approaches: antibiotics to prevent infection, a special medication called octreotide to reduce fluid production, and a low-fat diet with special oils that are easier for the body to process. The patient improved quickly, and by one week after surgery, ultrasound showed the fluid was completely gone. She went home in good health and remained healthy for the next three years.

The doctors believe the twin pregnancy may have caused this condition in two ways: the enlarged uterus from carrying two babies may have squeezed the lymphatic tubes in the mother’s body, or pregnancy hormones may have relaxed the lymphatic vessel walls, allowing fluid to leak out.

Case reports are important because they document rare medical situations that doctors might not otherwise know about. By sharing this case, doctors can teach other physicians to recognize similar situations in their own patients. This helps improve diagnosis and treatment of extremely uncommon conditions.

This is a single case report, which is the lowest level of medical evidence. It describes what happened to one person, not a large group. However, because chylous ascites in pregnancy is so rare (this appears to be the first reported case in twins), even a single case provides valuable information. The diagnosis was confirmed with laboratory testing, and the patient was followed for three years, which strengthens the reliability of the report. Readers should understand this describes one person’s experience and cannot be generalized to all pregnant women

What the Results Show

The main finding was the successful identification and treatment of chylous ascites in a twin pregnancy. The patient presented with severe abdominal pain and nausea at 32 weeks gestation. During emergency cesarean section, doctors discovered 2000 milliliters of milky-white fluid in the abdominal cavity. Laboratory testing showed triglyceride levels of 1945 mg/dL (normal is less than 110 mg/dL), which confirmed the diagnosis of chylous ascites.

The treatment approach combined three strategies: a low-fat diet supplemented with medium-chain triglyceride oil (a special type of fat that’s easier to digest), octreotide injections (a medication that reduces fluid production), and broad-spectrum antibiotics to prevent infection. This combination approach was highly effective.

By day 7 after surgery, ultrasound imaging showed complete resolution of the ascites—the fluid was completely gone. The patient was discharged in stable condition and experienced no complications or recurrence during three years of follow-up. Both the mother and babies recovered well from the emergency delivery.

The case provides insight into possible causes of chylous ascites in pregnancy. The doctors identified two potential mechanisms: First, the enlarged uterus from carrying two babies may have compressed the thoracic duct (the main lymphatic vessel in the body), increasing pressure and causing fluid leakage. Second, pregnancy hormones, particularly progesterone, may have relaxed the smooth muscle in lymphatic vessel walls, causing them to dilate and leak fluid. These mechanisms help explain why this condition is so rare and why it occurred in this particular case.

Chylous ascites during pregnancy is exceptionally rare, with only a handful of cases reported in medical literature before this one. Most previously reported cases occurred in women carrying single babies, not twins. This case is notable because it appears to be the first documented case of chylous ascites in a twin pregnancy. The successful treatment with conservative management (diet and medication rather than surgery) aligns with current medical practice for this condition, though the rarity of cases means treatment approaches continue to evolve.

This is a single case report describing one patient’s experience, so the findings cannot be applied to other pregnant women. Case reports cannot prove cause and effect or identify risk factors. The proposed mechanisms for how the condition developed are based on theory rather than proven fact. Additionally, because this condition is so rare, it’s impossible to know if the treatment approach used in this case would work equally well for other patients. Doctors cannot make general recommendations based on one person’s outcome

The Bottom Line

For pregnant women: If you experience severe, unexplained abdominal pain during pregnancy, especially in the later months, contact your healthcare provider immediately. This is not a common condition, but prompt medical attention is important for any severe pregnancy symptoms. For healthcare providers: Consider chylous ascites in the differential diagnosis when evaluating unexplained ascites in pregnant patients, particularly in twin pregnancies. The combination of milky-appearing fluid and very high triglyceride levels can confirm the diagnosis. Conservative treatment with dietary modification and medication should be tried first, with surgery reserved for cases that don’t respond to treatment. Confidence level: Low to moderate—based on a single case report

This case is most relevant to obstetricians, maternal-fetal medicine specialists, and emergency physicians who care for pregnant women. It’s also important for radiologists and surgeons who may encounter this condition. For the general public, this case is educational but should not cause alarm, as chylous ascites in pregnancy is extraordinarily rare. Pregnant women should be aware that severe abdominal pain always warrants medical evaluation, but this specific condition is not a common concern

In this case, the patient showed dramatic improvement within one week of treatment, with complete resolution of fluid by day 7 post-surgery. However, this timeline may not apply to all cases. The condition resolved before delivery of the babies, and the patient remained healthy throughout the three-year follow-up period. Most cases of chylous ascites resolve after delivery, though this patient’s resolved before delivery due to treatment

Want to Apply This Research?

  • If a user is pregnant and has experienced abdominal symptoms, they could track: daily abdominal pain level (0-10 scale), presence of nausea or vomiting, abdominal bloating or distension, and any fluid accumulation noticed. This data would be valuable to share with healthcare providers if symptoms develop
  • Users who are pregnant should use the app to set reminders for regular prenatal appointments and to log any unusual symptoms immediately. Creating a symptom alert system for severe abdominal pain would prompt users to contact their healthcare provider right away rather than waiting
  • For pregnant users, implement a symptom tracking dashboard that monitors abdominal symptoms, fluid retention, and digestive changes. Include a direct alert feature for severe symptoms that recommends immediate medical contact. Post-pregnancy, users could track recovery progress and any lingering symptoms during follow-up care

This case report describes an extremely rare medical condition affecting one patient. It is not intended to diagnose, treat, or prevent any disease. If you are pregnant and experience severe abdominal pain, nausea, or any concerning symptoms, contact your healthcare provider or emergency services immediately. Do not use this information for self-diagnosis. All medical decisions should be made in consultation with qualified healthcare professionals who know your complete medical history. This article is for educational purposes only and does not replace professional medical advice