{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T15:40:36Z","timestamp":1773675636064,"version":"3.50.1"},"reference-count":12,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T00:00:00Z","timestamp":1773532800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Ventriculoperitoneal (VP) shunting remains the standard definitive treatment for progressive neonatal obstructive hydrocephalus. Congenital chylous ascites is an uncommon neonatal condition, most often related to developmental lymphatic abnormalities. The concurrence of hydrocephalus requiring VP diversion with congenital chylous ascites is exceptionally rare and may first become apparent during abdominal access for shunt placement. Awareness of this possibility is clinically important because milky peritoneal fluid at shunt surgery can mimic gastrointestinal injury, and persistent postoperative abdominal fluid collections may be misattributed to shunt-related complications. Case Presentation: A late-preterm female infant (36 weeks\u2019 gestation; birth weight 2.3 kg) presented with congenital hydrocephalus. Cranial ultrasonography was consistent with isolated aqueductal stenosis. Preoperative abdominal ultrasonography demonstrated mild ascites. On 27 May 2025, a VP shunt was placed for obstructive hydrocephalus. Upon entering the peritoneal cavity, milky-white fluid was encountered, prompting concern for bowel injury; however, careful exploration showed no gastrointestinal perforation. Ascitic fluid analysis revealed markedly elevated triglycerides (2300 mg\/dL), confirming chylous ascites. The VP shunt was completed without an intraoperative complication. During follow-up, the infant showed appropriate growth (weight 3.0 kg; length 50 cm), while ascites persisted, and she was referred for multidisciplinary evaluation and management. Conclusions: This case highlights an exceptionally rare association of congenital chylous ascites with isolated aqueductal stenosis, identified incidentally during VP shunt insertion. Prompt intraoperative recognition, biochemical confirmation, and coordinated follow-up are essential to distinguish congenital chylous ascites from shunt-related abdominal fluid collections and to guide appropriate multidisciplinary care.<\/jats:p>","DOI":"10.3390\/reports9010086","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T13:32:07Z","timestamp":1773667927000},"page":"86","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Congenital Chylous Ascites in a Neonate with Isolated Aqueductal Stenosis: A Case Report and Literature Review"],"prefix":"10.3390","volume":"9","author":[{"given":"Bandar M.","family":"Abuageelah","sequence":"first","affiliation":[{"name":"General Medicine Practice Program, Batterjee Medical College, Obhur 61961, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mona H.","family":"Alfaifi","sequence":"additional","affiliation":[{"name":"General Medicine Practice Program, Batterjee Medical College, Obhur 61961, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Musaab I.","family":"Alnaami","sequence":"additional","affiliation":[{"name":"General Medicine Practice Program, Batterjee Medical College, Obhur 61961, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mubarak M.","family":"Alshahrani","sequence":"additional","affiliation":[{"name":"General Medicine Practice Program, Batterjee Medical College, Obhur 61961, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5790-4284","authenticated-orcid":false,"given":"Salma M.","family":"Jammali","sequence":"additional","affiliation":[{"name":"General Medicine Practice Program, Batterjee Medical College, Obhur 61961, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed F.","family":"Hamoda","sequence":"additional","affiliation":[{"name":"Surgery Department, Saudi German Hospital, Khamis Mushait 62451, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed H.","family":"Alshehri","sequence":"additional","affiliation":[{"name":"Surgery Department, Saudi German Hospital, Khamis Mushait 62451, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.3171\/2014.7.PEDS14322","article-title":"Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force. Pediatric hydrocephalus: Systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants","volume":"14","author":"Mazzola","year":"2014","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Huang, C., Liu, Y., Han, T., Wei, Y., Gu, X., and Li, R. (2025). Retrospective analysis of neonatal hydrocephalus over the past 12 years. BMC Pediatr., 25.","DOI":"10.1186\/s12887-025-05929-6"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"281","DOI":"10.3340\/jkns.2023.0044","article-title":"Permanent surgical treatment for posthemorrhagic hydrocephalus in preterm infants","volume":"66","author":"Harada","year":"2023","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Chang, C.C., Chiu, N.C., Huang, C.C., Liang, M.L., and Ho, C.S. (2025). Early detection of hydrocephalus in infant presenting aqueductal stenosis after endoscopic third ventriculostomy: Two case reports. J. Med. Ultrasound.","DOI":"10.4103\/jmu.JMU-D-25-00001"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"117","DOI":"10.2458\/lymph.5404","article-title":"Chylous ascites in the neonate: A narrative review","volume":"55","author":"Rocha","year":"2022","journal-title":"Lymphology"},{"key":"ref_6","first-page":"34","article-title":"Management and outcome of chylous ascites in children: A CARE compliant case series","volume":"1","author":"Kotb","year":"2021","journal-title":"Pediatr. Sci. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s40124-025-00354-w","article-title":"Chylous ascites in pediatric patients: Approach and management","volume":"13","author":"Fawaz","year":"2025","journal-title":"Curr. Pediatr. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"423","DOI":"10.3171\/ped.2005.102.4.0423","article-title":"Unusual findings during abdominal placement of a ventriculoperitoneal shunt: Report of three cases","volume":"102","author":"Tubbs","year":"2005","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1007\/s00381-020-04793-2","article-title":"Chyloperitoneum following open myelomeningocele repair: Dealing with an extremely rare finding","volume":"37","author":"Mavridis","year":"2021","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.1007\/s42399-021-00907-2","article-title":"Ventriculo-peritoneal shunt in the presence of chylous ascites\u2014Is it safe?","volume":"3","author":"Shumon","year":"2021","journal-title":"SN Compr. Clin. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1111\/apt.14284","article-title":"Review article: The diagnostic approach and current management of chylous ascites","volume":"46","author":"Lizaola","year":"2017","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1159\/000048344","article-title":"Measurement of cerebrospinal fluid output through external ventricular drainage in one hundred infants and children: Correlation with cerebrospinal fluid production","volume":"36","author":"Yasuda","year":"2002","journal-title":"Pediatr. Neurosurg."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/1\/86\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T14:12:54Z","timestamp":1773670374000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/1\/86"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,15]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["reports9010086"],"URL":"https:\/\/doi.org\/10.3390\/reports9010086","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,15]]}}}