A 36-year-old male patient with no remarkable personal history presented with asymptomatic macrohematuria for two weeks.
Physical examination, laboratory tests, urinary cytology and cystoscopy were normal.
Intravenous urography showed a mass effect in the lower pole of the right kidney, with cranial displacement of the collecting system.
Abdominal CT showed a 10 cm heterogeneous right renal mass in the lower pole, with peripheral enhancement, hypodense central areas and calcifications.
Laterocaval, retrocaval and interaortocaval lymph nodes were also observed, the largest being 4 cm.
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Right radical nephrectomy and retroperitoneal lymphadenectomy were performed by anterior abdominal approach.
The anatomopathological study revealed the existence of a clear cell renal adenocarcinoma of 10.5 x 9 cm and metastatic involvement of 9 of the 12 isolated lymph nodes, whose size ranged from 0.3 to 6 cm.
The postoperative period was uneventful until the 4th day, in which discharge of fluid was observed through the drainage catheter.
The fluid culture was sterile and its biochemical and cytological analysis was compatible with chylo: pH 7.581, 7600 cells stained/mm3 (82% mononuclear, 18% polynuclear), cholesterol: 352dl neutral.
Abdominal CT scan showed a liquid collection of 10 cm in the left portion of the mesentery, compatible with lymphocele.
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With the diagnosis of chylous ascites treatment consisting of suspension of oral diet and total parenteral nutrition was established.
Increase in output of the fistula within 48 hours after the start of treatment is manifested as chylosis (0.1 mg/8h, subcutaneous), manifest fall in drainage.
Isotopic lymphography (99mTc) was performed 12 and 24 days after the onset of the fistula, observing an accumulation of medial tracer to the right iliac chain, compatible with lymph node, without lymph node leakage.
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In the control CT, after 9 days without fistulous output, persistence of retroperitoneal chylocele was observed, allowing drainage CAT-guided.
The collection drainage was maintained up to 7 days, after 4 days without output.
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Parenteral nutrition was maintained in absolute diet and total nutrition for 15 days.
Treatment with octreotide was continued for 22 days.
Five months after surgery the patient remains clinically and radiologically free of disease and without evidence of chylous leakage.
