Chylous Lymphocyst Following Retroperitoneal Lymphadenectomy: A Case Report and Review of Treatment

Chylous lymphocyst or lymphocele following pelvic and para-aortic lymphadenectomy is rare. Clinically, patients usually present with abdominal distension or abdominal pain. The milky appearance of the cystic fluid reflects its high triglyceride content. Although specific guidelines for managing chylous lymphocyst are limited, the approaches used for chylous ascites can generally be applied. More than 70% of patients respond to conservative treatment, which includes a modified diet consisting of high protein, fat restriction, and medium-chain triglyceride supplementation. We present the case of a 45-year-old woman who developed a symptomatic 15-cm pelvic lymphocyst one month after surgical staging for a mucinous borderline ovarian tumor. Following the placement of a percutaneous catheter drainage (PCD), the initial output was 300-400 mL/day of clear serous fluid. Notably, a delayed chylous conversion occurred on the 20th day of drainage, the fluid turned milky and biochemical analysis confirmed a triglyceride level of 493 mg/dL. Initiation of a modified high-protein, fat-restricted diet resulted in a rapid decrease in drainage volume to 30 mL/day within 24 hours, alongside a return to clear yellowish appearance. This study aims to report the clinical manifestations and to summarize current therapeutic options for patients with chylous leakage.