The development of chylous ascites after emergency repair of a ruptured abdominal aortic aneurysm (AAA) is an extremely rare complication with potentially grave mechanical, nutritional, and immunologic consequences. A 54-year-old man with recurrent, symptomatic chylous ascites ultimately required insertion of a peritoneovenous shunt after non-operative measures failed to provide relief. This is the fourth reported case of chylous ascites following ruptured AAA and only the second treated by peritoneovenous shunt placement.