Bile ascites can develop after trauma, cholecystectomy, biliary tract surgery, hepatic surgery, liver biopsy, and percutaneous biliary drainage. Persistence of symptoms following cholecystectomy continues to be studied extensively. Post Cholecystectomy Syndrome. 6 It was suggested to occur as a result of peritoneal irritation caused by spillage of endometriotic cyst contents. We describe a 31-year-old female who presented 2 weeks postoperatively after laparoscopic cholecystectomy with abdominal distention and pain. This diagnosis should be suspected whenever persistent bloating and anorexia last for more than a few days; failure to recover as smoothly as expected is the most common early symptom of bile ascites. A 32-year-old man presented with severe abdominal pain and ascites. Read the Clinical Chemistry Journal's July 2017 Clinical Case Study and student discussion. Patients with ascites underwent cholecystectomy less often than patients without ascites (21% vs 39%; P = .002). Many factors were regarded as cause of persistence of symptoms. postoperative chylous ascites, or retroperitoneal lymph node dissection where there is significant injury to the cisterna chyli [5, 6]. It has never been reported after laparoscopic cholecystectomy. Context Chylous ascites a rare complication post cholecystectomy. We describe a 31-year-old female who presented 2 weeks postoperatively after laparoscopic cholecystectomy with abdominal distention and pain. The differential diagnosis included pancreatic ascites, chylous ascites, and a bile leak. Chylous ascites is a rare complication after many abdominal procedures. We propose a potential relationship between acute biliary pancreatitis and the development of chylous ascites. Postoperative massive ascites, occasionally with pleural and pericardial effusion, was reported after laparoscopic treatment of pelvic endometriosis as either a short- or long-term complication. Chylous ascites is a rare complication after many abdominal procedures. These collections typically occur in the right or the left supramesocolic spaces. Amylase concentration in ascites several fold greater than serum was consistent with a pancreatic leak. His medical history included diagnosis of Sandifer syndrome, scoliosis requiring 3 spinal surgeries, microgastria, and hiatal hernia repair, and most recently, laparoscopic cholecystectomy (7 weeks prior). In the present case, the patient developed pancreatic ascites likely due to trauma to the pancreatic duct during laparoscopic cholecystectomy. Bile Ascites . Spontaneous chylous ascites after laparoscopic cholecystectomy: a case report Arpit Bansal1, Ashwani Kumar Bansal1*, Vandana Bansal2, Mamta Singh3 Dr. INTRODUCTION Chylous ascitis refers to collection of milky creamy fluid rich in triglyceride content above200 mg/dL and rich in small lymphocytes in peritoneal cavity.1,2 Rationale: Gallstone disease is commonly worldwide and safely treated by laparoscopic cholecystectomy.Chylous ascites is a rare but serious complication of many abdominal operations. Pancreatic Ascites Surgeons must watch for the clinical manifestations of bile ascites after laparoscopic cholecystectomy. Presences of long cystic duct remnant, stone in remnant cystic duct, incomplete or subtotal cholecystectomy were blamed. In cholecystectomy it is uncertain what degree of injury has occurred for the development of chylous ascites. We describe the diagnosis and management of chylous ascites post cholecystectomy. 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