Retrograde Transvenous Lymphatic Embolization for Refractory Chylous Ascites after Laparoscopic Distal Gastrectomy: A Case Report.

INTRODUCTION: Chylous ascites is a rare complication of gastric cancer surgery and is usually managed conservatively. However, treating refractory cases with persistent high-output drainage remains challenging. Although lymphangiography with subsequent embolization has recently emerged as a minimally invasive treatment option, the identification of the leakage site is often difficult using conventional intranodal approaches. In such cases, retrograde transvenous lymphangiography and embolization may be feasible and safe. Herein, we describe a case of refractory postoperative chylous ascites after laparoscopic gastrectomy that was successfully treated with retrograde transvenous lymphangiography and subsequent embolization.

CASE PRESENTATION: An 85-year-old man underwent a laparoscopic distal gastrectomy with D1+ lymph node dissection for gastric cancer. On POD 4, chylous ascites developed after the initiation of oral intake. Despite conservative management, including fasting and the administration of a somatostatin analog, the high-output drainage persisted at 1000-2000 mL/day, resulting in severe hypoalbuminemia. Intranodal lymphangiography failed to identify the leakage site. Therefore, retrograde transvenous lymphangiography was performed through the left venous angle, which revealed leakage at the level of the 3rd lumbar vertebra. Subsequently, lymphatic embolization was performed, which led to a rapid decrease in the drainage output. No complications were observed during the procedure. The patient recovered without any recurrence and was discharged 22 days after the procedure.

CONCLUSIONS: Retrograde transvenous lymphatic embolization may be an effective and safe treatment option for refractory chylous ascites after gastrectomy, particularly when the leakage site cannot be identified using conventional intranodal lymphangiography.