Case Report Combined Chylothorax and Chylous Ascites Complicating Liver Transplantation: A Report of a Case and Review of the Literature Tommy Ivanics , 1 Semeret Munie, 1 Hassan Nasser , 1 Shravan Leonard-Murali, 1 Atsushi Yoshida, 2 Shunji Nagai, 2 Kelly Collins, 2 Marwan Abouljoud, 2 and Michael Rizzari 2 1 Department of General Surgery, Henry Ford Hospital, Detroit, MI, USA 2 Department of Transplantation Surgery, Henry Ford Hospital, Detroit, MI, USA Correspondence should be addressed to Tommy Ivanics; tivanic1@hfs.org Received 29 March 2019; Accepted 4 July 2019; Published 21 July 2019 Academic Editor: David Conti Copyright © 2019 Tommy Ivanics et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Chyle leaks may occur as a result of surgical intervention. Chyloperitoneum, or chylous ascites afer liver transplantation, is rare and the development of chylothorax afer abdominal surgery is even more rare. With increasingly aggressive surgical resections, particularly in the retroperitoneum, the incidence of chyle leaks is expected to increase in the future. Here we present a unique case of a combined chylothorax and chyloperitoneum following liver transplantation successfully managed conservatively. Risk factors for chylous ascites include para-aortic manipulation, extensive retroperitoneal dissection, use of a Ligasure device, and early enteral feeding as well as early enteral feeding. Te clinical presentation is typically insidious and may include painless abdominal distension. Diagnosis can be made by noting characteristic milky white drainage which on laboratory examination has a total fuid triglyceride level >110 mg/dl, an ascites/serum triglyceride ratio of >1 and a leukocyte count in fuid >1000/uL with a lymphocyte predominance. Chyle leaks may lead to signifcant morbidity and mortality. Numerous management options exist, with conservative nonoperative measurements leading to the most consistent and successful outcomes. Tis includes a step-up approach beginning with dietary modifcations to a low-fat or medium chain triglyceride diet followed by nil per os with addition of total parenteral nutrition and somatostatin analogues such as octreotide. Rarely do patients require more invasive treatment. Early recognition and appropriate management are imperative to mitigate this complication. 1. Introduction Chyle leaks, manifesting as chylothorax or chyloperitoneum/ chylous ascites, can be broadly categorized into non-trau- matic and traumatic etiologies. Te latter can occur as a result of surgery. Chylous ascites is a rare complication afer liver transplantation with reported incidences of 0.6- 7% [1–7]. Chylothorax afer abdominal surgery and liver transplantation in particular is even more rare [8, 9]. Tere appears to be a correlation between incidence of chyle leaks and the extent of surgical resection [10]. Te incidence of this complication is likely to rise in the future with increasingly aggressive surgical resections, especially those involving the retroperitoneum, inferior vena cava reconstructions, lymph node dissections or in the setting of post neoadjuvant therapy [11]. While the majority of chyle leaks can successfully be managed conservatively, they can dramatically prolong length of hospital stay [10] and result in signifcant morbidity and mortality. Taking into account all these factors highlights the importance of early recognition and appropriate manage- ment of this rare complication. We herein present a unique case of combined chylothorax and chyloperitoneum following liver transplantation success- fully managed conservatively. 2. Case Description Te patient is a 56-year-old female with end-stage liver disease (true MELD score 12, exception MELD score 22) secondary to chronic hepatitis C genotype 1 likely contracted secondary to blood transfusion afer a motor vehicle accident 40 years prior who presented for a deceased donor Liver transplantation. She had a 35-pack year smoking history. Preoperative morbidities included grade 2 esophageal varices, Hindawi Case Reports in Transplantation Volume 2019, Article ID 9089317, 5 pages https://doi.org/10.1155/2019/9089317