Chylous ascites caused by lymphatic vessel obstruction due to compression from advanced gastric and esophageal malignant tumors is relatively rare in clinical practice. It is often accompanied by malnutrition, hypoproteinemia, and a poor prognosis. We report a patient with an advanced gastric and esophageal malignant tumor complicated by chylous ascites. Management focused on symptom control and individualized nutritional support, including intravenous medium-chain triglyceride emulsion together with enteral nutritional emulsion administered through a nasoenteric tube, paracentesis for symptomatic relief, and supportive measures. Although the underlying malignancy determined the overall prognosis, and the patient died in May 2023, the interventions provided temporary improvement in symptoms and nutritional status. This case highlights the importance of early recognition of chylous ascites and of prioritizing symptom relief, individualized nutritional strategies, and palliative goals of care in patients with advanced malignancy.

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