Congenital chylous ascites (CCA) is a rare neonatal lymphatic disorder with an incidence of approximately 1/20,000 live births. It results from abnormal lymphatic development leading to chyle leakage into the peritoneal cavity, which may cause severe malnutrition, infection, and respiratory distress in fetuses and neonates. This article reports a case of fetal ascites detected by prenatal ultrasound screening and suspected as CCA after prenatal evaluation; a fetal peritoneal-amniotic shunt (PAS) was performed in the late gestational period as an intrauterine intervention. After birth, the diagnosis of CCA was confirmed, and individualized conservative treatment was initiated, including fasting, total parenteral nutrition, intermittent abdominal paracentesis with drainage, and continuous intravenous infusion of octreotide. During treatment, the infant's ascites volume, nutritional status, and liver and kidney function were dynamically monitored. The ascites gradually decreased, gastrointestinal function gradually recovered, and the infant was successfully transitioned to normal feeding before discharge. After discharge, the patient was readmitted due to recurrent ascites. Both octreotide and somatostatin administration induced drug-related cholestasis, which resolved after discontinuation. Regular follow-up with abdominal ultrasound at 2, 3, and 4 months of age showed small amounts of fluid that gradually decreased, with complete resolution by 6 months. At 9 months of age, the infant demonstrated good physical growth, normal motor, neurological, and cognitive development, and no signs of recurrent infection or immunodeficiency. This case suggests that an integrated management model characterized by "late‑gestation fetal PAS combined with early postnatal octreotide sequential therapy" can effectively control CCA, avoid surgical intervention, and achieve favorable long-term outcomes. Such reports are rare in the current literature, and this model provides a feasible clinical reference for the perinatal management of massive CCA.

1. FawazN, AdlerA, RadhakrishnanK, et al. Chylous ascites in pediatric patients: approach and management[J]. Curr Pediatr Rep, 2025, 13(1): 17. DOI: 10.1007/s40124-025-00354-w.

2. AjithD, JoyA, PournamiF, et al. Congenital chylous effusions in neonates: evolving protocols for optimized outcomes[J]. Int J Adv Med Health Res, 2025, 12(2): 117. DOI: 10.4103/ijamr.ijamr_88_25.

3. BaranM, KahveciS, AksoyB, et al. Refractory infantyl chylous ascites treatment by everolimus[J]. Medeniyet Med J, 2025, 40(2): 110-113. DOI: 10.4274/MMJ.galenos.2025.82284.

4. SooklinL, AnandAJ, RajaduraiVS, et al. Management of large congenital chylous ascites in a preterm infant: fetal and neonatal interventions[J]. BMJ Case Rep, 2020, 13(9): e235849. DOI: 10.1136/bcr-2020-235849.

5. 周佳亮, 朱娟, 朱小春, 等. 20例先天性乳糜腹患儿的处理及预后[J]. 中华围产医学杂志, 2022, 25(8): 615-619.ZhouJL, ZhuJ, ZhuXC, et al. Management and prognosis of 20 cases of congenital chylous ascites in 20 infants[J]. Chin J Perinat Med, 2022, 25(8): 615-619. DOI: 10.3760/cma.j.cn113903-20220214-00124.

6. KliegmanRM, BlumNJ, TaskerRC, et al. Nelson textbook of pediatrics[M]. 22nd ed. Philadelphia, PA: Elsevier, 2025.

7. DuletzkeNT, KiralyLN, MartindaleRG. Chylothorax and chylous ascites: overview, management, and nutrition[J]. Nutr Clin Pract, 2023, 38(3): 557-563. DOI: 10.1002/ncp.10973.

8. 李奔, 张榕, 刘银芝, 等. 不同喂养方案治疗新生儿乳糜胸及乳糜腹的临床疗效研究[J]. 中华新生儿科杂志, 2025, 40(2): 65-70.LiB, ZhangR, LiuYZ, et al. Clinical efficacy study of different feeding regimens in the treatment of neonatal chylothorax and chylous ascites[J]. Chin J Neonatol, 2025, 40(2): 65-70. DOI: 10.3760/cma.j.cn101451-20240506-00152.

9. JeenaS, LondheAC, JoshiA, et al. An unusual variant of ascites: congenital chylous ascites[J]. Int J Contemp Pediatr, 2025, 12(12): 2074-2077. DOI: 10.18203/2349-3291.ijcp20253800.

10. 中国医师协会新生儿科医师分会营养专业委员会, 中国医师协会新生儿科医师分会早产儿专业委员会. 新生儿肠外营养管理专家共识(2025)[J]. 中国当代儿科杂志, 2025, 27(3): 247-261.Nutrition professional committee of the neonatology branch of chinese medical doctor association, Premature infant professional committee of the neonatology branch of chinese medical doctor association. Expert consensus on parenteral nutrition management in neonates (2025)[J]. Chin J Contemp Pediatr, 2025, 27(3): 247-261. DOI:10.7499/j.issn.1008-8830.2411156.

11. RochaG. Chylous ascites in the neonate: a narrative review[J]. Lymphology, 2022, 55(3): 101-115. DOI: 10.2458/lymph.5404.

12. HorganR, YoussefJA, LevyAT, et al. Etiology and outcome of isolated fetal ascites: a systematic review[J]. Obstet Gynecol, 2021, 138(6): 897-904. DOI: 10.1097/AOG.0000000000004605.

13. AbuageelahBM, AlfaifiMH, AlnaamiMI, et al. Congenital chylous ascites in a neonate with isolated aqueductal stenosis: a case report and literature review[J]. Rep Clin Pract Surg Cases, 2026, 9(1): 86. DOI: 10.3390/reports9010086.

14. RochaG, ArnetV, SoaresP, et al. Chylothorax in the neonate—a stepwise approach algorithm[J]. Pediatr Pulmonol, 2021, 56(10): 3093-3105. DOI: 10.1002/ppul.25601.

15. BhardwajR, VaziriH, GautamA, et al. Chylous ascites: a review of pathogenesis, diagnosis and treatment[J]. J Clin Transl Hepatol, 2018, 6(1): 1-9. DOI: 10.14218/JCTH.2017.00035.

16. ZahradnikovaP, PechanovaR, FedorovaL, et al. Laparoscopic management of the congenital chylous ascites in a newborn: case report[J]. J Minim Access Surg, 2023, 19(4): 548-551. DOI: 10.4103/jmas.jmas_304_22.

17. CapriatiT, CarciofiA, GrimaldiC, et al. Case report: pediatric chylous ascites beyond congenital malformations-infectious causes and nutritional management with a literature review[J]. Front Pediatr, 2026, 14: 1779054. DOI: 10.3389/fped.2026.1779054.

18. LeeS, HurS, ChoiYH, et al. MR lymphangiography: congenital lymphatic flow disorders[J]. Invest Radiol, 2025, 60(1): 84-94. DOI: 10.1097/RLI.0000000000001112.

19. YousifT, NewboldS, OnyeadorN, et al. Chylous ascites in an infant, a case report and literature review[J]. Eur J Med Case Rep, 2024, 8(1): 1-5. DOI: 10.24911/ejmcr.173-1586346005

20. ZouH, Van BEYNENJ, RitzemaJ. Management of idiopathic infantile chylous ascites[J]. Cureus, 2024, 16(3): e55965. DOI: 10.7759/cureus.55965.

21. AlhasoonMA. The use of high dose octreotide in management of neonatal chylothorax: review[J]. J Neonatal Perinatal Med, 2021, 14(4): 457-461. DOI:10.3233/NPM-200644.

22. NakanoTA, DoriY, GumerL, et al. How we approach pediatric congenital chylous effusions and ascites[J]. Pediatr Blood Cancer, 2022, 69(S3): e29246. DOI: 10.1002/pbc.29246.

23. OlivieriC, NanniL, MasiniL, et al. Successful management of congenital chylous ascites with early octreotide and total parenteral nutrition in a newborn[J]. BMJ Case Rep, 2012, 2012: bcr2012006196. DOI: 10.1136/bcr-2012-006196.

24. BelliniC, CabanoR, De AngelisLC, et al. Octreotide for congenital and acquired chylothorax in newborns: a systematic review[J]. J Paediatr Child Health, 2018, 54(8): 840-847. DOI: 10.1111/jpc.13889.

25. Gomes-PorrasM, Cárdenas-SalasJ, Álvarez-EscoláC. Somatostatin analogs in clinical practice: a review[J]. Int J Mol Sci, 2020, 21(5): 1682. DOI: 10.3390/ijms21051682.

26. YeW, LiuZ. Real-world drug safety study of somatostatin analogs based on the food and drug administration adverse event reporting system database[J]. Eur J Pharmacol, 2025, 1005: 178053. DOI: 10.1016/j.ejphar.2025.178053.

27. Lopez-GutierrezJC, TovarJA. Chylothorax and chylous ascites: management and pitfalls[J]. Semin Pediatr Surg, 2014, 23(5): 298-302. DOI: 10.1053/j.sempedsurg.2014.09.011.

28. SuP, ZhangZ. Nano carbon tracer in the repairing of congenital abdominal chylorus leakage[J]. Indian J Pediatr, 2024, 91(3): 294-296. DOI: 10.1007/s12098-023-04557-1.

29. RiyantoHW, NugrahadiT. Chylous ascites in pediatric lymphangiomatosis: definitive localization and surgical guidance with 99mTc-nanocolloid SPECT/CT[J]. Biosci Med, 2025, 9(11): 9479-9494. DOI: 10.37275/bsm.v9i11.1435.