Dual-target lymphatic embolization for refractory chylous ascites after nephroureterectomy

We report a case of refractory chylous ascites following nephroureterectomy and para-aortic lymphadenectomy for renal pelvic carcinoma, which was successfully treated with percutaneous lymphatic embolization. An 83-year-old man underwent nephroureterectomy with para-aortic lymph node dissection for renal pelvic carcinoma. Postoperatively, >1000 mL/day of chylous ascites was continuously drained. Despite conservative management, high-output ascites persisted. Transnodal lymphangiography via the inguinal lymph nodes and post-lymphangiographic CT revealed lymphatic leakage at the nephroureterectomy site. Percutaneous lymphatic embolization was planned as a minimally invasive procedure. Under CT guidance, embolization of a lymphopseudoaneurysm and para-aortic lymph nodes near the leakage site was successfully performed using N-butyl cyanoacrylate. Ascitic fluid output decreased significantly postoperatively, and the drainage tube was removed the following day. This case highlights the importance of post-lymphangiographic CT in identifying actionable lymphatic targets and demonstrates that an anatomically tailored dual-target embolization strategy can achieve effective sealing when central duct access is not feasible.