Chyloabdomen in critically ill patient after Hartmann’s procedure

Post-surgical chylous ascites (CA) is extremely rare in colon surgery, known as the extravasation of creamy fluid rich in triglycerides accumulating in the peritoneal cavity. The incidence of CA after colorectal surgery remains between 1 and 6.5%. A 71-year-old female presented to the Emergency Department complaining of generalized abdominal pain, weakness and anorexia for several days ago and episodes of hematochezia which started the day before admission. Biopsy from colonoscopy revealed mucinous adenocarcinoma. Rectal mass resection with Hartmann’s procedure was performed due to obstructive recto-colonic mass. Pathology report confirmed pT4aN0M0 tumor invading through the visceral peritoneum. On post-operative Day number 4, drainage output increased, changing appearance to a whitish color. The diagnosis of CA was confirmed by obtaining >550 mg per dL of triglycerides. Changes to a high-protein, low-fat with medium chain fatty acids were made to her enteral diet. After 48 hours of diet adjustment, the drainage output of CA resolved.