Combination of preoperative lymphangiography using lipiodol and intraoperative lymphangiography using Evans Blue facilitates the accurate identification of postoperative chylous fistulas.

In a 61-year-old woman who underwent extensive retroperitoneal lymph node dissection for rectal cancer, postoperative chylous ascites developed. The site of the lymphatic leak was evident on the lymphangiogram with lipiodol taken prior to the surgical repair of the leak, and another site seen on the intraoperative lymphangiogram using Evans Blue. A direct surgical repair led to good results. Therefore, the combination of pre- and intraoperative lymphangiography facilitates the successful surgical management of rare but alarmingly dangerous postoperative chylous ascites.