Chylocolporrhea or chylous vaginal discharge: diagnostic conundrum with therapeutic challenge

Chylocolporrhea or chylous vaginal discharge is an extremely rare manifestation of chylous reflux syndrome. Continuous loss of chyle adversely affects quality of life and results in increased morbidity due to the chronic loss of nutrients. Diagnosis and management of this condition is very challenging.

A 35-year-old multiparous lady presented with the chief complaints of excessive milky vaginal discharge for 10 years. Microscopic and biochemical analysis of vaginal discharge along with hysteroscopy confirmed diagnosis of chylocolporrhea. Lymphoscintigraphy along with magnetic resonance imaging revealed site of leakage from the right external iliac lymphatics. She was started on medium-chain triglycerides-rich diet and meticulous ligation of all visible megalymphatics with tension-free lymphovenous anastomosis was done to right external iliac vein.

Chylocolporrhea can be managed successfully using operative and nonoperative modalities.