Refractory Chylous Ascites Leading to Chylothorax Following Extended Right Hepatectomy for Intrahepatic Cholangiocarcinoma

Chylous ascites, a rare but severe complication of abdominal surgery, often results from lymphatic vessel damage during procedures, such as extended resection and lymphadenectomy. Although conservative management through dietary modifications and medications is the primary approach, refractory cases may lead to severe complications including nutritional deficiencies and even death. Herein, we report a case of refractory chylous ascites that progressed to chylothorax after extended right hepatectomy with lymph node dissection for intrahepatic cholangiocarcinoma. A 73-year-old woman developed chylous ascites one month postoperatively, which subsequently perforated the diaphragm and led to a massive chylothorax. Despite conservative management including fasting and drainage, surgical intervention was required to resolve the condition. This case highlights the importance of timely recognition and treatment of refractory chylous ascites after extensive liver resection.