A 75-year-old woman developed a rare complication called chylous ascites (fluid buildup in the belly) nearly 100 days after surgery for endometrial cancer. Instead of needing another surgery to fix it, doctors successfully treated it using three approaches: changing her diet to easier-to-digest foods, giving her a medication called octreotide, and using special imaging to find and seal the leak. This case shows that even when this rare complication appears very late after surgery, doctors can treat it without operating again, allowing patients to continue their cancer treatment on schedule.

The Quick Take

  • What they studied: How doctors successfully treated a rare complication (chylous ascites) that developed nearly 100 days after endometrial cancer surgery using non-surgical methods
  • Who participated: One 75-year-old woman who had advanced endometrial cancer and underwent extensive surgery including removal of the uterus, ovaries, and nearby lymph nodes
  • Key finding: The patient’s rare fluid buildup was successfully controlled using diet changes, medication, and imaging-guided treatment without needing another surgery, even though it appeared much later than usual
  • What it means for you: If you or a loved one develops this rare complication after gynecologic cancer surgery, doctors may be able to treat it without additional surgery. However, this is based on one patient’s experience, so talk with your medical team about your specific situation

The Research Details

This is a case report, which means doctors documented the medical story of one patient in detail. The doctors also reviewed 13 other published studies about this same complication to understand how it usually happens and how it’s typically treated. They looked at what tests confirmed the diagnosis, what images showed, and how the patient responded to different treatments over time. This type of study is useful for describing unusual situations that doctors don’t see very often.

Case reports are important for rare medical problems because they help doctors learn about unusual presentations and successful treatments. By documenting this patient’s experience and comparing it to other cases in the medical literature, doctors can better understand how to recognize and treat this complication when it happens unexpectedly

This is a single case report, which is the lowest level of medical evidence. It describes one patient’s experience in detail but cannot prove that this treatment will work for everyone. The strength of this report comes from the detailed documentation and the review of similar cases in medical literature. Readers should understand this represents one successful example, not proof that all patients will have the same outcome

What the Results Show

The patient developed chylous ascites (fluid rich in fat and lymph) about 99 days after her cancer surgery, which is much later than the typical 4-21 day window when this complication usually appears. Doctors confirmed the diagnosis by testing the fluid from her belly and found it contained high levels of triglycerides (a type of fat). The patient was treated with three approaches: first, dietary changes starting with fasting and then switching to a special diet using medium-chain triglycerides (easier-to-digest fats); second, a medication called octreotide that reduces fluid production; and third, a CT-guided lymphangiography procedure that helped identify and seal the leak. This combination of treatments successfully controlled the fluid buildup without requiring surgery.

An important secondary finding was that the patient remained cancer-free for 1 year and 8 months after her surgery. This is significant because successful management of the chylous ascites complication allowed her to continue with her planned cancer treatment without delays. The case review of 13 other studies showed that conservative (non-surgical) treatments are considered first-line therapy for this condition, with surgery reserved only for cases that don’t respond to other treatments

This case is notable because chylous ascites typically appears within 3 weeks of surgery, but this patient’s delayed presentation at nearly 100 days is unusual. The review of previous cases confirms that conservative treatments using diet, medication, and imaging-guided procedures are increasingly preferred over surgery. The successful outcome in this delayed case suggests that even when the complication appears much later than expected, the same non-surgical approaches can still work effectively

This is a single case report, so the results apply to one patient and may not work the same way for everyone. The patient was 75 years old with advanced cancer, so results might differ in younger patients or those with different cancer stages. We don’t know if this treatment approach would work as well for other patients or how common delayed presentations like this actually are. Longer follow-up would be needed to confirm the treatment’s long-term success

The Bottom Line

Based on this case, doctors should consider non-surgical treatments as the first approach for chylous ascites, even when it appears later than usual after surgery. The recommended stepwise approach includes: (1) dietary changes using medium-chain triglycerides, (2) medication with octreotide, and (3) imaging-guided procedures to locate and seal leaks. Surgery should be reserved for cases that don’t respond to these conservative measures. Confidence level: Low to moderate, as this is based on one case and a review of other cases, not controlled research studies

This information is most relevant for gynecologic cancer patients who develop unusual fluid buildup after surgery, their family members, and their medical team. It’s also important for gynecologic surgeons and oncologists who manage these rare complications. Patients without this complication don’t need to worry about this information, but it’s good to know that if this rare problem develops, there are effective non-surgical treatment options available

In this case, the patient’s fluid buildup was controlled over several weeks to months using the combined approach of diet, medication, and imaging-guided treatment. Most patients typically see improvement within weeks of starting conservative treatment, though individual timelines vary. If conservative measures don’t work within a reasonable timeframe, surgical options may be considered

Want to Apply This Research?

  • If recovering from gynecologic cancer surgery, track daily abdominal symptoms including bloating, swelling, discomfort level (1-10 scale), and any changes in appetite or digestion. Note any dietary changes and how you feel after eating different foods
  • Users recovering from gynecologic cancer surgery can use the app to log their diet, especially noting how they feel after eating different types of fats and foods. This creates a personal record to share with their doctor and helps identify any patterns related to digestive comfort or abdominal changes
  • Set up weekly check-ins to review abdominal symptoms, dietary intake, and any new or worsening symptoms. Create alerts to remind users to report significant changes (increased bloating, new pain, or fluid accumulation) to their medical team promptly, as early detection of complications allows for faster treatment

This case report describes the experience of one patient and should not be considered medical advice for your specific situation. Chylous ascites is a rare complication that requires professional medical diagnosis and treatment. If you are recovering from gynecologic cancer surgery and develop abdominal swelling, fluid buildup, or other concerning symptoms, contact your doctor immediately. Treatment decisions should always be made in consultation with your medical team based on your individual health status, cancer type, and medical history. This information is educational and does not replace professional medical care.