[Conservative management of postoperative lymphatic fistula]

We describe the case of a diabetic patient who presented with a renal abscess that was surgically managed with nephrectomy. At the forth post-surgical day, the patient showed the presence of a "milky" looking fluid amounting to 1200 ml in 24 h through a Penrose drainage placed in the surgical resection site. After several studies, a diagnosis of lymphatic fistula was made. The first dietary management technique tried was not satisfactory, and total parenteral nutrition management was decided upon, obtaining a satisfactory outcome within a few days. We reviewed the literature where we found scant reported information on lymphatic fistulas following retroperitoneal surgery and we consider that because of more aggressive surgical techniques and more advanced technology for increased patient survival, doctors will witness a higher incidence of chylous fistulas or chylous ascites, which is why it is important to be aware of this complication.