Peer-reviewed veterinary case report
Massive chylous ascites after laparoscopic hernia repair
By Abadi Chiriti J et al.·2026·General Surgery·View original on Europe PMC →
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Original publication title: Massive Recurrent Chylous Ascites Following Laparoscopic Inguinal Hernia Mesh Repair.
Plain-English summary
A 35-year-old woman had surgery to fix what was thought to be a right inguinal hernia, but afterward, she developed a rare condition called chylous ascites, which is when a fatty fluid builds up in the abdomen. Three weeks after her surgery, she started to notice her belly was getting bigger and she was losing weight. Doctors found a large amount of this fluid and tried various treatments, including a special diet and medications, but nothing worked. Eventually, they had to do another surgery to remove the mesh used in her hernia repair, which revealed damaged lymphatic vessels. After fixing these vessels, she recovered well and has not had any further issues in the three years since.
Abstract
Chylous ascites is a rare condition characterized by the accumulation of lipid-rich lymph within the peritoneal cavity. While typically secondary to malignancy or trauma, its occurrence following laparoscopic inguinal hernia repair is exceptional. While clinical findings are usually sufficient to diagnose an inguinal hernia and justify surgical intervention, this case demonstrates that rare lymphatic malformations can closely mimic common pathology. A high index of clinical suspicion and further imaging should be employed when diagnostic ambiguity exists to avoid such devastating iatrogenic complications. This case contributes a novel presentation and management approach to the literature. A 35-year-old female, initially misdiagnosed with a right inguinal hernia, underwent elective laparoscopic transabdominal preperitoneal (TAPP) repair with mesh placement. Three weeks postoperatively, she developed progressive abdominal distension and weight loss. CT imaging revealed massive free fluid consistent with ascites, and paracentesis yielded 9 L of chylous fluid with elevated triglyceride levels. Conservative management, including a medium-chain triglyceride (MCT) diet and somatostatin analogues, failed to achieve resolution. Lymphography subsequently identified multiple leak sites in the right groin; however, an attempt at percutaneous embolization was unsuccessful. Definitive surgical exploration was performed, during which the mesh was removed, revealing injured lymphatic vessels at the femoral ring. These vessels were ligated, and Tisseel® (Baxter) fibrin sealant was applied. The patient recovered uneventfully, with no recurrence at the three-year follow-up. This case highlights that lymphatic malformations can mimic inguinal hernias and lead to severe iatrogenic complications if not considered in the differential diagnosis when clinical findings or imaging are ambiguous. When conservative measures fail, surgical intervention, specifically mesh removal and direct ligation, is essential. In this patient, the presence of the mesh likely perpetuated the lymphatic leak. This complex scenario required multidisciplinary management; ultimately, prevention relies on accurate preoperative diagnosis.
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Search related cases →Original publication on Europe PMC: https://europepmc.org/article/MED/41684978