Background: Chylous ascites has been uncommonly observed with bowel obstruction. This unusual phenomenon may be secondary to various disease processes with a correct diagnosis seldom made preoperatively.
Case presentation: The patient was a 64-year-old man with a medical history of distal gastrectomy for gastric cancer over 30 years ago. We diagnosed him with internal volvulus by several examinations and decided to perform emergency laparotomy. His abdominal pain improved markedly after inserting a long intestinal tube. At laparotomy, there was a large amount of chylous ascites in the abdomen. Despite an edematous small intestine with prominent lymphatic vessels, the cause of the volvulus was unclear, and there was also no evidence of ischemic change in the small intestine. A biochemical analysis of the peritoneal fluid revealed elevated values of triglyceride levels.
Conclusion: We experienced a case of volvulus of the small intestine with chylous ascites in which strangulation was successfully relieved using a long intestinal tube.