The use of octreotide in the treatment of chylothorax

Abstract

Chylothorax is defined as abnormal accumulation of lymphatic fluid in the pleural space. Chylothorax is a rare case and generally occurs after thoracic and cardiac procedures. Chylothorax causes respiratory and nutritional problems and a significant mortality rate. Good knowledge of the underlying pathophysiology enables early diagnosis and prevention of the chronic complications related to immunodeficiency and malnutrition. Octreotide is a long-acting somatostatin analog that can reduce lymphatic fluid production and has been used as a new strategy in the treatment of chylothorax. In gastrointestinal tract, somatostatin and octreotide act on somatostatin receptors to reduce intestinal blood flow by vasoconstriction of the splanchnic vessels; decrease gastrointestinal motility; and inhibit gastric, pancreatic, and biliary secretions, thus reducing intestinal fat absorption and lymphatic flow in the thoracic duct. Octreotide is generally considered to be safe, with only occasional side effects. The side effects of octreotide are mainly related to its vasoconstrictive and antisecretory actions. The general consensus is for conservative management with octreotide to be instituted for 1 week before consideration of surgery. In case of either high flow rate chylothorax, especially after oesophageal surgery, or failure of conservative treatment with octreotide, operation is indicated.