Traumatic Thoracic Duct Transection managed with Left Thoracoscopy: A Case Report and Review of Literature

Abstract

ABSTRACT Context Chylothorax is an uncommon complication after penetrating trauma to the chest and the neck. Only 25% of all chylothorax cases are related to penetrating trauma. We report such a case on a transmediastinal stab wound, managed by video-assisted thoracic surgery. Case report A 48-year-old male presented to our level I trauma center after sustaining a stab wound to the right chest. Initial workup revealed a left side pneumothorax. After chest tube placement 700 ml of blood and milky fluid were recovered. The patient was managed initially with TPN, without success. On day 3, he was taken to the OR for a left VATS. The thoracic duct was dissected and the injury identified and controlled with hemoclips. The intervention was successful and the patient was discharged on POD #4. Discussion Chylothorax are classified and managed according to the daily output of the fistula. While low output chylothorax are more frequent, more likely related to malignancy of the mediastinum and lymph nodes, and more likely to close with nonsurgical management; traumatic chylothorax are generally high output and more likely to require surgical intervention. The different approaches to this difficult pathology are reviewed. How to cite this article Smith-Singares E, Saied A. Traumatic Thoracic Duct Transection managed with Left Thoracoscopy: A Case Report and Review of Literature. Panam J Trauma Critical Care Emerg Surg 2013;2(2):97-99.