Chylous lymphorrhea is an uncommon postoperative complication resulting from disruption of lymphatic
channels, most frequently reported after retroperitoneal or oncologic surgeries. Its occurrence following
open myomectomy is exceedingly rare. We report a challenging case of persistent chylous lymphorrhea
in a 47-year-old woman following open abdominal myomectomy for multiple large uterine fibroids. The
patient developed a high-output chylous collection originating from the left retroperitoneal/pararenal
region, confirmed biochemically by elevated triglyceride levels. Despite prolonged conservative
management including drainage, dietary modification, albumin supplementation, and somatostatin
therapy, the lymphorrhea persisted. A subsequent exploratory laparotomy with total abdominal
hysterectomy and bilateral salpingo-oophorectomy failed to definitively identify a leaking lymphatic
source. The condition ultimately followed a prolonged but regressive course under conservative
management, with near-complete resolution over one year. This case highlights the diagnostic and
therapeutic challenges of postoperative lymphorrhea after benign gynecologic surgery and emphasizes
the importance of patience with conservative management.
