Lymphangiography for diagnosis and treatment of traumatic chylous leak: a preliminary report

Abstract

Objective To investigate the diagnostic and therapeutic roles of lymphangiography in 13 patients with traumatic chylous fistula to improve the treatment of this disease. Methods Twelve cases of postoperative chylous leakage after initial conservative treatment for 5-14 days and one case of chylous leakage after chest compression injury treated at Shanghai Pudong Hospital from May 2008 to January 2019 were enrolled in this study. Unilateral dorsal foot lymphangiography was performed in all 13 cases before reoperation, and the treatment method was re-evaluated according to the results of lymphangiography. Results Chyle leakage was observed in eight cases according to dorsal foot lymphangiography, and five of them were cured by surgery. The other three cases with chyle leakage and four cases who failed to show chyle leakage were cured by conservative treatment (7-45 days), since chyle flow decreased significantly after lymphography. The case of chest compression injury who failed to show chylous leak had deteriorated disease after conservative treatment and died after reoperation. Conclusion The location of chylous leak can be determined by lymphangiography of the anterior foot back, which is conducive to improving the success rate of surgery. For patients with reduced chylous leak after lymphangiography, conservative treatment can be continued regardless of whether the chylous leak is confirmed or fails to be shown. It is difficult to achieve the ideal therapeutic effect because of the blindness of reoperation for patients who cannot clearly show chylous leak. Key words: Chylous; Lymphangiography; Diagnosis; Treatment