Successful treatment of chylous leakage with delayed presentation after endometrial cancer surgery using dietary therapy, octreotide, and computed tomography‐guided lymphangiography: A case report and literature review
Abstract
Objective
Chylous ascites (CA) is a rare yet clinically significant complication following gynecologic cancer surgery, with incidence rates of 0.17 % to 9%. We aimed to describe a case of CA with a delayed clinical presentation nearly 100 days postoperatively in a patient with advanced endometrial cancer and to review the management strategies.
Methods
We retrospectively evaluated a 75‐year‐old patient who underwent radical hysterectomy, bilateral salpingo‐oophorectomy, extended lymphadenectomy (pelvic and para‐aortic), and partial omentectomy for stage IIIB endometrial cancer. Data collected included onset timing, ascitic fluid analysis, imaging findings, and treatment responses. Additionally, a narrative review identified 13 relevant studies discussing the onset, risk factors, diagnosis, and therapies for post‐operative CA in gynecologic oncology.
Results
Although CA typically appears within 4 to 21 days, our patient developed CA at approximately post‐operative day 99. Diagnostic paracentesis confirmed triglyceride‐rich ascitic fluid, establishing the diagnosis of CA. Dietary modification (fasting followed by medium‐chain triglyceride diet), octreotide therapy, and computed tomography (CT)‐guided lymphangiography effectively controlled the chylous leakage without requiring surgery.
Conservative measures—low‐fat or medium‐chain triglyceride diets, total parenteral nutrition, and somatostatin analogs—are considered first‐line, while lymphangiography/embolization and eventual surgical ligation may be needed for refractory cases.
Conclusions
This case illustrates that CA with a delayed clinical presentation can be successfully treated with a stepwise conservative approach comprising dietary therapy, octreotide, and CT‐guided lymphangiography, even when presenting more than 3 months postoperatively. Moreover, our patient remained free of disease recurrence at 1 year and 8 months postoperatively, underscoring that timely management of CA can avoid delays in adjuvant therapy.
