Chylous ascites following retroperitoneal lymphadenectomy for testes cancer.

BACKGROUND

A 31-year-old man underwent a radical orchiectomy for a stage I mixed germ-cell tumor with angiolymphatic invasion. A subsequent laparoscopic retroperitoneal lymphadenectomy was complicated by a laceration to the aorta at the ostia of the more inferior of two right renal arteries. This was repaired following conversion to an open laparotomy. The patient presented 14 days later with genital swelling and increasing abdominal girth.

INVESTIGATIONS: Physical examination, abdominal and pelvic CT, laboratory albumin testing, lymphoscintogram and lymphangiogram.

DIAGNOSIS: Chylous ascites with tracking of lymphatic fluid into the left groin through a defect in the internal inguinal ring.

MANAGEMENT: Conservative management with salt restriction, a medium-chain fatty-acid diet and diuretics; exploratory laparoscopy, during which a small left inguinal hernia was repaired and chylous fluid was drained. Following further leakage, the patient was placed on total parenteral nutrition, followed by image-guided sclerotherapy with doxycycline.