Aim <p>To evaluate and discuss the clinical management of the 10-year-old patient who presented to us with chyluria and discuss the complications from intervention.</p> Methods <p>Data were collected prospectively from the electronic patient record system. The patient presented with persistent chyluria and intermittent abdominal pain. Ultrasound (USS) and MRI tests found no abnormal lymphatic malformations. The C.T. lymphangiogram showed subtle contrast flow into the urinary bladder, suggesting possible ectasia of the left medial lymphatic channel causing a lymph leak into the bladder. Urology and interventional radiology collaborated for cystoscopy and sclerotherapy to locate a leaking bladder lymphatic channel, with an on-table lymphogram planned for diagnosis. On cystoscopy day, no chyluria was present. Fluoroscopy with methylene blue and contrast was performed on the lymph node and contrast was observed in the lymphatic channel, but no methylene blue leaked into the bladder. The lymphatic submucosal channel was filled with methylene blue and seen in the bladder submucosa but there was no clear lesion to inject the sclerosant. After the post-operative procedure, the patient experienced significant swelling and cellulitis/lymphangitis, which was managed conservatively. The swelling retreated but became more localised to the groin, persisting a month later. An MRI revealed patchy reactive intramuscular and fascial oedema around the pelvis.</p> Discussion <p>The case involves chyluria due to a lymphatic malformation, causing fluid leakage into the urinary tract, but lymphangitis could indicate an inflammatory reaction to methylene blue used during the procedure, necessitating further investigation for better patient management.</p>