Management of Refractory Chylous Ascites

Retroperitoneal lymph node dissection (RPLND) is a procedure with both diagnostic and therapeutic benefits. We present a patient who underwent retroperitoneal lymph node dissection for a PET-positive left para-aortic lymph node identified on surveillance. Subsequently developing chylous ascites. Initial conservative management with dietary modification, total parenteral nutrition, somatostatin analogues, and percutaneous drainage proved ineffective. Trans-nodal lymphangiography was performed. The sclerosant effect of lipiodol alone provided temporary improvement, however, the chylous ascites recurred. Definitive treatment was achieved via CT-guided percutaneous lymphatic embolization using NBCA glue combined with lipiodol. Post procedure, the chylous ascites was treated successfully and patient discharged.