Management of chylous ascites following pancreaticoduodenectomy surgery using radiotherapy: A case report and review of literature.

INTRODUCTION

Chylous ascites (CA) is a rare but significant clinical complication that requires careful consideration for effective treatment. CA often results from cisterna chyli injury following abdominal surgeries, especially pancreaticoduodenectomy (PD), due to triglyceride-rich lymphatic fluid accumulation in the peritoneal cavity. Management of CA ranges from conservative approaches to interventional strategies, particularly in refractory cases.

CASE PRESENTATION

A 76-year-old male who developed CA following PD for resectable ampulla of Vater cancer. Despite initial conservative treatments, including total parenteral nutrition (TPN), albumin supplementation, and octreotide administration, management of the patient's CA persisted with high-output ascitic drainage.

DISCUSSION

Although conservative management is often effective, it may fail in cases of high-output or persistent CA. Radiotherapy, by inducing localized fibrosis and sealing lymphatic leaks, represents a safe and efficacious option for refractory cases. The literature underscores the importance of multidisciplinary, stepwise management that incorporates conservative, interventional, and surgical modalities for optimal patient outcomes.

CONCLUSION

CA is an uncommon and challenging postoperative complication of PD that requires a multidisciplinary management strategy. Although conservative management is the first-line approach, this case highlights the potential role of radiotherapy as an effective and safe adjunctive therapy for refractory cases.