Chylous Ascites Complicating Modified Radical Hysterectomy for Placenta Percreta

BACKGROUND: Chylous ascites is defined as the pathologic accumulation of lymphatic fluid within the peritoneal cavity and has been reported to complicate gynecologic surgeries, with an incidence of 0.17-2%. We report a case of chylous ascites after complex surgery for placenta percreta. CASE: A 26-year-old woman underwent cesarean delivery followed by bilateral uterine artery embolization and modified radical hysterectomy at 26 5/7 weeks of gestation for placenta percreta invading the urinary bladder. No surgical dissection was performed above the pelvic brim or deep into the pelvic sidewalls. On postoperative day 4, milky fluid consistent with chylous ascites was noted coming from a percutaneous drain. This completely resolved after 12 days of conservative management with intravenous nutritional support. CONCLUSION: Chylous ascites is a potential complication of modified radical hysterectomy for placenta percreta that responds to conservative management.