Low-Dose Radiation Therapy (LDRT) for Lymphatic Obliteration in Persistent Chylous Ascites - A Case Report

Sep 29, 2026

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Chylous ascites is a rare postoperative complication typically linked to inadvertent injury of retroperitoneal lymphatic vessels, and it poses major therapeutic difficulty when standard measures fail. The report describes a patient with persistent lymphatic leakage after retroperitoneal lymphadenectomy for recurrent testicular cancer who did not respond to multiple conventional interventions. Low-dose external beam radiotherapy achieved complete resolution and no recurrence at two-year follow-up, supporting radiotherapy as a potentially effective option for lymphatic fistulas.

LanguageEnglish

CategoryResearch & Report

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Pages5

Reading Time13 min

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Abstract

Introduction

Case Presentation

Preoperative history and cancer recurrence

Postoperative chylous ascites and initial management

Review began 11/12/2025 Review ended 11/30/2025 Published 12/07/2025 © Copyright 2025 Guerrero Lizcano et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98646 Open Access Case Report Low-Dose Radiation Therapy (LDRT) for Lymphatic Obliteration in Persistent Chylous Ascites: A Case Report Eduardo Guerrero Lizcano 1, Yuli Natalia Otero Pabon 1 , Javier Rodriguez Corredor Santiago Ardila Giraldo 1 , Andrés González Ramírez 3, Sofía Dávila Garzón 4 2 , 1. Radiation Oncology, Instituto Nacional de Cancerología, Bogotá, COL 2. Radiation Oncology, Instituto Médico Oncológico, Neiva, COL 3. Nuclear Medicine, Instituto Nacional de Cancerología, Bogotá, COL 4. Internal Medicine, Hospital San Juan de Dios, Armenia, COL Corresponding author: Yuli Natalia Otero Pabon, [nataliaotero.38@gmail.com](nataliaotero.38@gmail.com) Abstract Chylous ascites is a rare postoperative complication, typically associated with extensive abdominal procedures and caused by inadvertent injury to the retroperitoneal lymphatic vessels. Its management represents a therapeutic challenge, particularly in cases refractory to conventional strategies. We present the case of a patient with persistent lymphatic leakage following retroperitoneal lymphadenectomy for recurrent testicular cancer, who failed multiple standard interventions. Given the refractory nature of the condition, low-dose external beam radiotherapy was administered, resulting in complete resolution with no recurrence at two-year follow-up. This case highlights radiotherapy as a potentially effective therapeutic option for the management of lymphatic fistulas. Categories: Nuclear Medicine, Urology, Radiation Oncology Keywords: lymphatic fistula, lymphoscintigraphy, postoperative chylous ascites, radiation theraphy, refractory ascites Introduction Chylous ascites is an uncommon postoperative complication [1], resulting from inadvertent disruption of the retroperitoneal lymphatic vessel, leading to an abnormal communication between major retroperitoneal lymphatic channels and the peritoneal cavity, causing lymph leakage and accumulation [2] . Its incidence varies depending on the type of surgery: 7% following complex abdominal procedures [3], 9% after retroperitoneal lymphadenectomy [4], 5% following laparoscopic nephrectomy [5], and 1 .2% after lymph node dissection for testicular cancer [6] . Due to its rarity, there is no consensus on standardized diagnostic and therapeutic approaches, making its management particularly challenging [2] . We report the case of a patient with a history of testicular cancer who underwent retroperitoneal surgery for tumor recurrence and subsequently developed postoperative chylous ascites refractory to conventional treatment (nutritional suspension, embolization, surgical ligation), which was successfully managed with radiotherapy. Case Presentation A 32-year-old male was presented in September 2021, with a diagnosis of mixed germ cell tumor (50% seminoma and 50% mature teratoma) post right radical orchiectomy, stage IS (pT1NxM0S 1), with no adjuvant therapy. Five months later, serum lactate dehydrogenase (LDH) levels were found to be elevated, and a computed tomography (CT) scan revealed a 6 cm retroperitoneal mass in the right renal parahilar region with circumferential infiltration of the ipsilateral artery and vein. The patient received three cycles of bleomycin, etoposide, and cisplatin, achieving normalization of tumor markers; however, retroperitoneal disease still persisted. An open retroperitoneal lymphadenectomy was performed, with removal of seven lymph nodes and two lymph node conglomerates; histopathological analysis confirmed pure seminoma involvement in the conglomerates of lymph nodes; the re

FAQs

What causes chylous ascites after surgery?

It results from inadvertent disruption of retroperitoneal lymphatic vessels, creating an abnormal communication with the peritoneal cavity and causing lymph leakage and accumulation.

Why was low-dose external beam radiotherapy chosen in this case?

The condition was refractory to multiple conventional strategies, including nutritional suspension, embolization, and surgical ligation, so the multidisciplinary team used radiotherapy as an alternative.

How was the fistula localized and what radiotherapy regimen was used?

Lymphoscintigraphy localized the fistula, then a VMAT plan delivered 10 Gy in 10 daily fractions of 1 Gy (five days per week) to the defined treatment volume.

Sep 29, 2026

Upload by jayni