Isolated Lymphatic Injury Mimicking Bladder Rupture in a Young Male Following Blunt Trauma: A Case Report

Blunt abdominal trauma can be difficult to evaluate, especially when an unusual injury mimics a far more common one. We present a case of a 17-year-old boy who was struck in the abdomen by bicycle handlebars. His initial imaging suggested a possible bladder rupture because of the presence of both intraperitoneal and extraperitoneal fluid. A retrograde CT cystogram, however, ruled out any bladder injury. Because of his worsening condition, he underwent an urgent laparoscopy followed by exploratory laparotomy, which revealed a large volume of milky-white free fluid, suggestive of chyle, within the abdomen. Laboratory analysis of the aspirated fluid showed a high triglyceride level of 1,079 mg/dL, confirming the chylous nature of the fluid. There was an enlarged and engorged cisterna chyli in the retroperitoneum suggesting lymphatic injury. Treatment involved applying fibrin sealant in the region of the cisterna chyli, placing a peritoneal drain, and keeping a diet based on medium-chain triglycerides. The patient recovered well without any recurrence of chylous ascites. This case highlights the need to consider rare lymphatic injuries causing posttraumatic chylous ascites when evaluating blunt abdominal trauma with diffuse abdominal fluid collection, particularly when common injuries have been ruled out but the patient's clinical status continues to worsen.