# Management of chylous ascites following pancreaticoduodenectomy surgery using radiotherapy: A case report and review of literature

## TL;DR

A 76-year-old man developed chylous ascites after pancreatic cancer surgery, and radiotherapy was used successfully when other treatments failed.

## Contribution

This case report highlights radiotherapy as a novel and effective treatment for refractory chylous ascites following pancreaticoduodenectomy.

## Key findings

- Conservative treatments failed to manage high-output chylous ascites in a post-PD patient.
- Radiotherapy effectively reduced ascitic drainage by inducing localized fibrosis and sealing lymphatic leaks.
- Multidisciplinary management is crucial for optimal outcomes in refractory chylous ascites cases.

## Abstract

Chylous ascites (CA) is a rare but significant clinical complication that requires careful consideration for effective treatment. CA often results from cisterna chyli injury following abdominal surgeries, especially pancreaticoduodenectomy (PD), due to triglyceride-rich lymphatic fluid accumulation in the peritoneal cavity. Management of CA ranges from conservative approaches to interventional strategies, particularly in refractory cases.

A 76-year-old male who developed CA following PD for resectable ampulla of Vater cancer. Despite initial conservative treatments, including total parenteral nutrition (TPN), albumin supplementation, and octreotide administration, management of the patient's CA persisted with high-output ascitic drainage.

Although conservative management is often effective, it may fail in cases of high-output or persistent CA. Radiotherapy, by inducing localized fibrosis and sealing lymphatic leaks, represents a safe and efficacious option for refractory cases. The literature underscores the importance of multidisciplinary, stepwise management that incorporates conservative, interventional, and surgical modalities for optimal patient outcomes.

CA is an uncommon and challenging postoperative complication of PD that requires a multidisciplinary management strategy. Although conservative management is the first-line approach, this case highlights the potential role of radiotherapy as an effective and safe adjunctive therapy for refractory cases.

•Chylous ascites is a rare and challenging complication following pancreaticoduodenectomy for pancreatic cancer.•Initial conservative treatments were unsuccessful in managing the patient’s high-output ascitic drainage.•Radiotherapy can be effectively used in the treatment of refractory chylous ascites.•A multidisciplinary management strategy ensures optimal patient outcomes.

Chylous ascites is a rare and challenging complication following pancreaticoduodenectomy for pancreatic cancer.

Initial conservative treatments were unsuccessful in managing the patient’s high-output ascitic drainage.

Radiotherapy can be effectively used in the treatment of refractory chylous ascites.

A multidisciplinary management strategy ensures optimal patient outcomes.