Successful Transhepatic Lymphangiography and Embolization for Chylous Ascites following Right Nephrectomy and Inferior Vena Cava Tumor Thrombectomy.

The case was a 71-year-old woman who had right renal cell carcinoma with inferior vena cava invasion. After the nephrectomy, chylous ascites appeared. Despite conservative treatment, chylous ascites persisted. No lymphatic leakage was identified on transpedal lymphoscintigraphy, and retrograde thoracic duct cannulation from the left subclavian vein failed. A chylous pseudoaneurysm was identified on computed tomography and embolized percutaneously; however, chylous ascites persisted. Therefore, we performed transhepatic lymphangiography and embolization before placement of a peritoneovenous shunt, and chylous ascites resolved. Transhepatic lymphatic embolization may represent a valuable treatment option for postoperative chylous ascites. This case suggests that hepatoduodenal lymphatic leakage may occur after nephrectomy involving extensive manipulation of the pancreas head or hepatoduodenal ligament, possibly related to cross-communication between hepatoduodenal and mesenteric lymphatics.