A chyle fistula is a rare postoperative complication of total gastrectomy with D1/D2 lymphadenectomy. We report the case of a 50-year-old woman who underwent oncological total gastrectomy with D2 lymphadenectomy and Rouxen-Y reconstruction. On the seventh postoperative day, a milky discharge suggestive of chyle was observed in the Blake drain, which was confirmed by laboratory tests. Early therapy with octreotide was initiated for three days, resulting in a rapid reduction in output and conversion to serous drainage. The patient was discharged on the 11th day without the need for reoperation. This is an uncommon complication associated with extensive lymph node dissection in gastric cancer; there are no standardized treatment protocols, and management remains challenging. Conservative treatment includes fasting and total parenteral nutrition, with or without pharmacotherapy. Octreotide, a somatostatin analog, is associated with reduced chyle output and shorter hospital stay. Early recognition and multidisciplinary management are essential, and early pharmacological therapy is a potential adjunct in controlling complications.