A 38-year-old male patient was referred to the Nutrition Unit for chylous ascites. His previous history included the presence of smoking and repeated nephritic colic. eight months before coming to our clinic, he had been diagnosed with left testicular seminoma with retroperitoneal adenopathy (stage II C). He underwent surgery with a radical left orchiectomy. He subsequently received chemotherapy treatment with the BEP protocol (3 cycles of Bleomycin-Cisplatin-Etoposide and a fourth cycle of Cisplatin-Etoposide). After chemotherapy, a significant decrease in the size of the adenopathic mass was observed (4.2 x 3 cm in its maximum diameter versus 11 x 6 cm initially), but given the persistence of the adenopathies, it was decided to perform a retroperitoneal lymphadenectomy. The operation passed without complications in the immediate postoperative period, but three weeks after surgery she consulted for abdominal pain and distension. Physical examination revealed a distended, hard, diffusely painful abdomen with signs of ascites. An ultrasound scan of the abdomen showed significant ascites. Abdominal computed tomography showed post-surgical changes of retroperitoneal lymphadenectomy and a large amount of free intra-abdominal fluid. Evacuative paracentesis was performed with extraction of 8,000 cc of milky ascitic fluid; analysis of the fluid showed: leukocytes 508/mm3, polymorphonuclear 14%, mononuclear 86%, triglycerides 875 mg/dl. Tumour origin was ruled out because necrosis and calcification were identified in the resected lymph nodes and tumour markers (AFP and HCG) were negative. Three weekly evacuating paracentesis were performed, extracting 3, 7 and 4 litres successively. At the Nutrition Clinic, the patient reported moderate asthenia with a feeling of early postprandial fullness. Physical examination revealed weight 66 kg, height 177 cm, ideal weight 79.2 kg, BMI 21.06, tricipital fold 12 mm (91.8% p50), arm muscle circumference 21.8 cm (89% p50), BP 115/71 mmHg, HR 72 bpm, normal cardiopulmonary ascultation with no signs of pleural effusion and abdominal examination with no relevant findings. The analytical evaluation showed: glucose 92 mg/dl (60-100), creatinine 1.2 mg/dl (0.8-1.3), urate 7.9 mg/dl (3.5-7.2), Na, K, Cl, calcium and phosphorus normal, liver profile normal, total cholesterol 233 mg/dl (HDL 52 mg/dl, LDL 153 mg/dl), triglycerides 152 mg/dl (< 150), total protein 6.4 g/dl (6.6-8.3), albumin 3.3 g/dl (3.5-5.2), Fe 63 μg/dl (70-180), ferritin 265 ng/ml (20-400), transferrin saturation 25% (15-40), transferrin 201 mg/dl (200-360), red blood cells 4.860.000/μl (4,400,000-5,800,000), haemoglobin 14.3 g/dl (13-17.3), MCV 87.2 fl (80-97), haematocrit 42.4% (38.9-51.4), leukocytes 6,760/μl (3,700-11,600), lymphocytes 830/μl (800-3,000), polymorphonuclear 5,250/μl (1,000-5,400), rest of white series normal, platelets 501,000/μl (125,000-350.000), prothrombin activity 89% (75-120), vitamin B12, 422 pg/ml (197-866), folate 7.7 ng/ml (3.1-17.5), zinc 52 μg/dl, vitamin A/retinol binding protein 0,8 (0.8-1.2), vitamin E/cholesterol 6 (6-12), vitamin D 35 ng/ml (30-100), PTH 33 pg/ml (12-65), B-HCG < 1 mIU/ml (0-5), AFP 3.32 ng/ml (0-16). The patient was diagnosed with mild protein-calorie malnutrition in the context of chylous ascites secondary to retroperitoneal lymphadenectomy. A high-protein diet with fat restriction and fractionated in 5-6 daily intakes was started along with MCT 20 ml daily, zinc sulphate 1 tablet daily, a multivitamin complex and 100 grams daily of a specific MCT-enriched supplement. This supplement provides 424 kcal and 11.4 grams of protein per 100 grams. With this therapeutic approach, the patient required only one evacuating paracentesis and 3 months later presented the following anthropometric data: weight 70.1 kg, tricipital fold 13 mm (100% p50), arm muscle circumference 23 cm (93% p50); the previously altered analytical parameters were also normalised.

