Successful treatment of chylous leakage with delayed presentation after endometrial cancer surgery using dietary therapy, octreotide, and computed tomography-guided lymphangiography: A case report and literature review

Objective: Chylous ascites (CA) is a rare yet clinically significant complication following gynecologic cancer surgery, with incidence rates of 0.17 % to 9%. We aimed to describe a case of CA with a delayed clinical presentation nearly 100 days postoperatively in a patient with advanced endometrial cancer and to review the management strategies. Methods: We retrospectively evaluated a 75-year-old patient who underwent radical hysterectomy, bilateral salpingo-oophorectomy, extended lymphadenectomy (pelvic and para-aortic), and partial omentectomy for stage IIIB endometrial cancer. Data collected included onset timing, ascitic fluid analysis, imaging findings, and treatment responses. Additionally, a narrative review identified 13 relevant studies discussing the onset, risk factors, diagnosis, and therapies for post-operative CA in gynecologic oncology. Results: Although CA typically appears within 4 to 21 days, our patient developed CA at approximately post-operative day 99. Diagnostic paracentesis confirmed triglyceride-rich ascitic fluid, establishing the diagnosis of CA. Dietary modification (fasting followed by medium-chain triglyceride diet), octreotide therapy, and computed tomography (CT)-guided lymphangiography effectively controlled the chylous leakage without requiring surgery. Conservative measures—low-fat or medium-chain triglyceride diets, total parenteral nutrition, and somatostatin analogs—are considered first-line, while lymphangiography/embolization and eventual surgical ligation may be needed for refractory cases. Conclusions: This case illustrates that CA with a delayed clinical presentation can be successfully treated with a stepwise conservative approach comprising dietary therapy, octreotide, and CT-guided lymphangiography, even when presenting more than 3 months postoperatively. Moreover, our patient remained free of disease recurrence at 1 year and 8 months postoperatively, underscoring that timely management of CA can avoid delays in adjuvant therapy.