Refractory Chylous Ascites After Robot-Assisted Radical Prostatectomy With Sequential Anatomically Distinct Lymphatic Leak Sites Identified by Repeat Lymphangiography.
Takayuki Owaki, Yasuhito Funahashi, Kosuke Tochigi et al.
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Case in brief
A 72-year-old man developed refractory chylous ascites following robot-assisted radical prostatectomy for high-grade prostate cancer. Initial conservative treatments failed, necessitating paracentesis, total parenteral nutrition, and lymphangiography. Surgical ligation temporarily controlled the leak, but recurrence prompted repeat lymphangiography, revealing a new leak site. Subsequent embolization of this site led to definitive resolution, and the patient was discharged after 117 days with improved nutrition and no recurrence at 5-year follow-up.
What made this case unusual
The case highlights the dynamic nature of lymphatic leak sites, as a new leak was identified after initial treatment appeared successful.
Diagnostic / clinical pearl
Clinicians should consider repeat lymphangiography in cases of recurrent chylous drainage after initial interventions, as lymphatic leak sites may change over time.
Why it matters
This case underscores the importance of a multidisciplinary approach in managing complex complications like refractory chylous ascites, integrating nutritional support and advanced imaging techniques.