chylous ascites has been reported after surgeries like abdominal aortic aneurysm repair , radical gastrectomy , duodenectomy , nephrectomy and wilm 's tumor resection . our literature search did not reveal any reports of chylous ascites after a gastric ulcer resection . we report about an elderly woman with a rare complication of chylous ascites after an emergent surgery for a perforated gastric ulcer . a 70-year - old woman developed sudden respiratory distress on 5 post - operative day after an elective c3-c7 cervical discectomy and fusion . the computed tomography ( ct ) scan of the chest revealed air under the diaphragm suspicious for hollow viscus perforation . she underwent an emergent surgery for drainage of hematoma in the neck along with an emergent laparotomy to repair a large perforated gastric ulcer distal to the gastro - esophageal junction . the abdominal drain revealed large amount of serous milky fluid at the rate of 1500 ml per day . the fluid analysis showed that the triglyceride level was 170 mg / dl and cholesterol level was 15 mg / dl . ascitic fluid triglyceride level greater than 110 mg / dl is diagnostic of chylous ascites . chylous ascites is a rare complication of a peptic ulcer resection which can be managed effectively with octreotide . chylous ascites has been reported after surgeries like abdominal aortic aneurysm repair , radical gastrectomy , duodenectomy , nephrectomy and wilm 's tumor resection . our literature search did not reveal any reports of chylous ascites after a gastric ulcer resection . we report about an elderly woman with a rare complication of chylous ascites after an emergent surgery for a perforated gastric ulcer . a 70-year - old woman developed sudden respiratory distress on 5 post - operative day after an elective c3-c7 cervical discectomy and fusion . the computed tomography ( ct ) scan of the neck revealed hematoma in the neck . the patient underwent an emergent surgery for drainage of hematoma in the neck along with an emergent laparotomy to evaluate for a hollow viscus perforation . a large perforated gastric ulcer distal to the gastro - esophageal junction was resected and a modified graham patch was placed . the patient had worsening of abdominal distention on 4 post - operative day after the repair of perforated gastric ulcer . the ct scan of abdomen showed fluid collection in the abdomen ( figure 1 ) . the abdominal drain revealed large amount of milky fluid at the rate of 1500 ml per day ( figure 2 ) . the ascitic fluid analysis showed that the triglyceride level was 170 mg / dl and cholesterol level was 15 mg / dl . computed tomography ( ct ) of the abdomen showing chylous ascites with a drain gross appearance of chylous fluid the hospital stay was complicated by sepsis . the patient recovered and was discharged home in a stable condition and did not have any ascites at discharge . lymphomas , metastatic malignancies , and abdominal surgeries , infections like tuberculosis commonly cause chylous ascites . ascitic fluid triglyceride level greater than 110 mg / dl is diagnostic of chylous ascites . gross appearance of the ascitic fluid corresponds poorly with absolute triglyceride levels because turbidity also reflects the size of the chylomicrons . a high total leukocyte count ranging between 232 - 2560 cells / mm with marked lymphocytic predominance is seen . total protein content varies from 1.4 - 6.4 g / dl , with a mean of 3.7 g / dl . symptoms can be relieved by measures like repeated paracentesis , diuretic therapy , salt and water restriction , elevation of legs and use of supportive stockings . our patient had an abdominal drain ; had salt and fluid restriction . a diet with medium - chain triglyceride decreases the drainage of chyle into the lymphatics . octreotide , a somatostatin analog , at a dose of 100 mcg subcutaneously thrice daily is used in the management of chylous ascites[68 ] . our patient was successfully treated with octreotide and a diet with medium chain triglycerides peritoneovenous shunting is an alternative treatment in a small number of patients but shunt failure is common . our patient 's hospital course was complicated by sepsis due to serratia marcescens and successfully treated with piperacillin - tazobactum . the prognosis depends on the treatment of the underlying disease or cause of chylous ascites . chylous ascites is a rare complication of a gastric ulcer resection which can be managed effectively with octreotide .
context : chylous ascites is the accumulation of milky chyle in the peritoneal cavity . 
 chylous ascites has been reported after surgeries like abdominal aortic aneurysm repair , radical gastrectomy , duodenectomy , nephrectomy and wilm 's tumor resection . 
 our literature search did not reveal any reports of chylous ascites after a gastric ulcer resection . 
 we report about an elderly woman with a rare complication of chylous ascites after an emergent surgery for a perforated gastric ulcer.case report : a 70-year - old woman developed sudden respiratory distress on 5th post - operative day after an elective c3-c7 cervical discectomy and fusion . 
 her past medical history was significant for cervical spondylosis . 
 the computed tomography ( ct ) scan of the chest revealed air under the diaphragm suspicious for hollow viscus perforation . 
 she underwent an emergent surgery for drainage of hematoma in the neck along with an emergent laparotomy to repair a large perforated gastric ulcer distal to the gastro - esophageal junction . 
 the patient had worsening of abdominal distention on 4th post - operative day . 
 the ct scan of abdomen showed fluid collection in the abdomen . 
 the abdominal drain revealed large amount of serous milky fluid at the rate of 1500 ml per day . 
 the fluid analysis showed that the triglyceride level was 170 mg / dl and cholesterol level was 15 mg / dl . 
 the fluid cultures did not grow any organism . 
 she responded to treatment with octreotide and a diet of medium chain triglyceride oil.conclusion:any obstruction or damage to the lymphatic channels results in chylous ascites . 
 lymphomas , metastatic malignancies , and abdominal surgeries commonly cause chylous ascites . 
 ascitic fluid triglyceride level greater than 110 mg / dl is diagnostic of chylous ascites . 
 chylous ascites is a rare complication of a peptic ulcer resection which can be managed effectively with octreotide .