Conservative management of chylous ascites after removal of a symptomatic growing retroperitoneal teratoma

Abstract

Background: Chylous ascites as a postoperative complication of gynecologic surgery is uncommon. Cases usually occur from trauma to the lymphatic system during retroperitoneal dissection. Initial management includes paracentesis with institution of a low-fat, medium-chain triglyceride diet and total parenteral nutrition (TPN). Surgical intervention may be required.

Case: A 19-year-old female patient with a history of an immature teratoma treated with chemotherapy presented with a retroperitoneal mass. Removal of the mass revealed mature teratoma and resulted in chylous ascites formation. Multiple paracenteses were performed in conjunction with dietary modification and TPN. Three months after the patient's surgery, the ascites spontaneously resolved.

Conclusion: Although surgical intervention is recommended after failure of conservative management, this case demonstrates that damage to the cisterna chyli may spontaneously resolve.