Iatrogenic chylous ascites, although extremely rare, appears to follow direct lymphatic injury during intra-abdominal surgery or to be due to specific postoperative complications such as pancreatitis. Statistically, truncal vagotomy has produced the largest number of cases. Any noticeable lymphatic injuries at the time of surgery should be controlled with appropriate sutures or clips. If iatrogenic chylous ascites develops postoperatively, a course of conservative treatment including multiple paracenteses should be tried for several weeks if reasonable nutritional balance can be maintained. If fluid volume does not diminish or the patient's nutritional status is jeopardized, early exploration should be undertaken. A lipophilic dye instilled Into the duodenum immediately before operation can help to locate the leak. Simple oversewing of the injured area is curative.
Lewis, Joseph W. and Storer, Edward H.
"The Management of Iatrogenic Chylous Ascites,"
Henry Ford Hospital Medical Journal
: Vol. 27
Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol27/iss2/13