80-year-old woman with AHT, CKD and hypothyroidism. Admitted to the geriatric ward for cognitive deterioration, she developed an acute abdomen with septic shock. An abdominal CT scan showed free fluid and thickening of the colonic wall. She underwent total colectomy with terminal ileostomy due to ischaemic colitis and splenectomy due to intraoperative bleeding. Postoperative evolution was favourable with resolution of shock. He tolerated enteral nutrition (EN), the ileostomy functioning well. On the 8th postoperative day, given the appearance of abdominal haematic drainage, a CT scan was performed, revealing haematoma of the surgical site. Subsequently, the drainage had a milky appearance, with a debit greater than 1,000 cc/d. On analysis: TG 166 mg/dL (blood TG 42, albumin 1.8), glucose 100 mg/dL, protein 0.83 g/dL, amylase 133, cells 145 (PMN 65%, M 32%), negative bacteriological culture, confirming the presence of FL.

TPN and somatostatin 3 mg/12 h i.v. were started. Drainage debit decreased progressively (BQ: TG 3 mg/dl, proteins 2.2 g/dl), subsiding after 5 days. Lymphoscintigraphy was therefore not deemed necessary. Low-fat, medium-chain fatty acid (MCFA)-rich, hyperproteic EN was added, with good tolerance.