Treatment of Iatrogenic Chyloretroperitoneum with Octreotide Following Spinal Deformity Correction: A Case Report.

Abstract

Chylous fluid leakage is a rare but well-described complication of anterior spinal surgery1-6. Conservative treatment, including a drainage tube and a low-fat diet or total parenteral nutrition supplemented with oral medium-chain triglycerides, has had varying success. Treatment is often prolonged, requiring continuous drainage for up to six months in some reported series7. The use of octreotide, a somatostatin analogue, was first described in the general surgery literature for the treatment of chylothorax resulting from a ruptured thoracic duct2,4,5. Numerous reports have confirmed the success of octreotide in the treatment of chylous accumulations in the chest, peritoneal cavity, and retroperitoneum, although, to the best of our knowledge, there is no mention of its use in the orthopaedic literature. We report a case of chyloretroperitoneum following lumbar hemivertebrectomy that was successfully treated with octreotide. The patient and his parents were informed that data concerning the case would be submitted for publication, and they provided consent. No patient identifiers were used in the course of this investigation in accordance with Health Insurance Portability and Accountability Act regulations. A five-year-old boy with a midlumbar hemivertebra had undergone convex hemiepiphysiodesis from a combined anterior and posterior approach when he was three years old. The curve continued to progress, and he subsequently underwent a hemivertebrectomy with anterior spinal fusion and posterior spinal instrumentation and fusion two years later (Figs. 1 through 4⇓⇓⇓). During the left-sided anterior approach, we noted substantial scarring from the initial surgical procedure. The ureter was identified and protected. A steady accumulation of clear fluid was noted after the approach was completed. The fluid formed fat droplets when irrigated and appeared to be chyle. The source could not be identified, …