A 60-year-old woman underwent laparoscopic left radical nephrectomy for a 9.7x7.5 cm lower pole renal tumour. During the operation, peritumoral para-aortic and mesocolon adhesions were found, where some large lymphatic vessels were ligated or coagulated, careful dissection of the hilum was performed and the distal ureter was clipped, with no intraoperative incidences and bleeding of less than 100 ml. The anatomopathological study showed solid, cystic clear cell renal carcinoma with areas of intratumoural bleeding, Fuhrman grade 2-3, stage pT2 pN0. The postoperative period was uneventful, a decrease in haemoglobin of 1.5 g/dl (from 13.2 to 11.7) was detected, and the patient was discharged from hospital five days later.
One month after discharge, he consulted for an increase in abdominal perimeter causing dyspnoea and discomfort, and imaging studies showed diffusely distributed ascites, suggestive of chylous ascites. Analyses showed Hb 11.1 g/dl, leukocyte formula and lymphocyte count normal, normal renal and hepatic function and mild hypo-proteinemia - albumin 2.9 g/dl (N: 3.4-5), total protein 5.8 g/dl (N: 6.4-8.2). She was treated conservatively, without diagnostic or evacuating paracentesis, with a low-salt and low-lipid diet, protein supplements and spironolactone 50 mg/day, with symptomatic and abdominal perimeter improvement, hospital discharge after six days, and complete healing confirmed by abdominal ultrasound one month later. Six months later she has no symptoms or signs of recurrence, and the abdominal ultrasound is normal.