case_images: PMC10901586_01
case_images: Timeline of the amount of ascites and the patient's weight since the first event. LVA, lymphovenous anastomosis.
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case_images: A 22-year-old female suffered from chylous ascites and chylothorax, which developed after laparoscopic left adnexectomy for a mature teratoma ( Fig. 1 ). Supplementary Fig. S1 , available in online version).
case_images: Magnetic resonance lymphangiography shows resolution of extensive enhancement ventral to the sacrum after the first embolization. Lymphatic reflux from the lymphatic vessels near the left ovarian vein is observed in the left pelvis and left salpinx. No obvious normal thoracic duct is visible.
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case_images: Magnetic resonance lymphangiography revealed prominently enhanced lymphatic vessels around left ovarian vein which were assumed to be due to abnormal reflux of the lymphatic flow resulting from obstruction of thoracic duct ( Fig. 2 ). Supplementary Fig. S2 , available in online version).
case_images: An intraoperative photograph, captured under a microscope, shows side-to-side anastomosis between lymphatics below the left para-aortic lymph node to mesenteric branch veins (arrow) during the first operation.
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case_images: Plastic surgeon performed LVA with 9-0 nylon in a side-to-side manner to decompress lymphatic pressure between the engorged lymphatics distal to the left para-aortic lymph node and branch of inferior mesenteric vein ( Fig. 3 ).  Supplementary Fig. S3 , available in online version).
case_images: Intraoperative intranodal lymphangiography through an inguinal lymph node was performed with indocyanine green injection through the right inguinal lymph node to visualize the residual leakage point. The left iliac lymph node is intact, but leakage from the retroperitoneal lymphatics is observed.
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case_images: Intraoperative inguinal intranodal lymphangiography with indocyanine green revealed additional leakage point from the retroperitoneal lymphatics ( Fig. 4 ; Video 1 ).
case_images: An intraoperative photograph, captured under a microscope, shows side-to-side (arrow) leakage between the right ovarian vein and the pseudo lumen of the para-aortic engorged lymphatic tissue during the second operation.
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case_images: FI23jul0413cr-5
case_images: The plastic surgeon created additional LVA at two sites between the right ovarian vein and the pseudo lumen of the engorged para-aortic lymphatic tissue ( Fig. 5 ). 