Abstract

BACKGROUND: Chyle leakage, resulting in chylous ascites, is an uncommon complication of abdominal surgery, with few cases reported following cholecystectomy. This report discusses a 64-year-old man who developed a chyle leak after laparoscopic cholecystectomy and outlines the diagnostic and treatment approaches. Prompt diagnosis is crucial, though often challenging, as symptoms are frequently nonspecific, such as abdominal discomfort or nausea. Notably, patients may present with a milky discharge from drains and wounds. Analysis of abdominal fluid is essential for diagnosis, with elevated triglyceride levels in peritoneal fluid confirming chyle leakage.

CASE REPORT: We describe a 64-year-old man who experienced chyle leakage on postoperative day 2 following laparoscopic cholecystectomy for acute cholecystitis.

A milky-white fluid was observed in the drain, and diagnosis was confirmed by elevated triglycerides in the fluid analysis. The chyle leakage decreased gradually, resolving completely by postoperative day 7 after dietary modifications and removal of the closed-suction silicone drain. At a 2-month follow-up, the patient was asymptomatic.

CONCLUSIONS: Although rare, chyle leakage is a possible postoperative complication of laparoscopic cholecystectomy. Early diagnosis and prompt multidisciplinary management are critical, even in cases with an uncomplicated surgical course and no anatomical anomalies. Employing a closed-suction silicone drain and monitoring its output are essential for early detection. Dietary modification is a key component of treatment, with surgical intervention reserved for cases where conservative management fails or in the presence of large volumes of chyle.