Case Of Postoperative Chylothorax Research Articles

Management of Chylothorax After Coronary Artery Bypass Grafting: Two Case Reports and Review of Literature

Chylothorax following coronary artery bypass graft (CABG) surgery is a very rare complication and its management is debatable. Opinions vary from early aggressive management to prolonged conservative treatment. We describe two cases of post-operative chylothorax following CABG and its management with intravenous octreotide.

Lymphoscintigraphy combined with single-photon emission computed tomography-computed tomography (SPECT-CT): A very effective imaging approach for identification of the site of leak in postoperative chylothorax

Post operative chylothorax is a known complication of various thoracic surgeries. It needs identification of precise site of leak in the thoracic duct. Lymphosicintigraphy can identify chyle leak but cannot delineate exact site of leak. SPECT-CT is precise in anatomic localisation and hence SPECT-CT should be combined with every lymphoscintigraphy in evaluation of clinically suspected case of post operative chylothorax. We report such a case.

Prevention of Chylothorax Complicating Extensive Esophageal Resection by Mass Ligation of Thoracic Duct: A Random Control Study

Chylothorax after esophagectomy remains a devastating postoperative complication. Prophylactic mass ligation of the thoracic duct during the extensive resection of esophageal cancer is used to prevent the chylothorax, but there are few published data about its effect. This randomized controlled study was designed to evaluate the preventive effect of thoracic duct mass ligation on postoperative chylothorax. Six hundred fifty-three patients undergoing transthoracic esophagectomy for cancer were randomly assigned to two groups: 328 patients received esophagectomy (preservation group) and 325 patients received thoracic duct mass ligation during esophagectomy (prevention group). The patients in whom chylothorax developed were identified and occurrence rates of chylothorax were compared between the two groups. The management and outcome of postoperative chylothorax was also recorded. Patients' demographic details were similar between the two groups. No major or minor intraoperative or postoperative complications related to prophylactic thoracic duct mass ligation were recorded. Chylothorax occurred in 8 patients, giving an incidence of 1.2%. In the preservation group, chylothorax occurred in 7 patients (2.1%), and in the prevention group, 1 case of chylothorax was found (0.3%). The incidence of postoperative chylothorax was significantly lower in the prevention group. Among the 8 cases of postoperative chylothorax, 6 patients made an uneventful recovery, but the other 2 patients died of complications (mortality rate, 25%). The technique of intraoperative thoracic duct mass ligation proved safe and effective. It minimized the risk of postoperative chylothorax in patients who underwent transthoracic esophagectomy for cancer.

Effect of thoracic duct ligation during transthoracic esophagectomy on the prevention of post-operative chylothorax in different tumor locations

To investigate the effect of thoracic duct ligation during transthoracic esophagectomy on preventing post-operative chylothorax in different tumor locations. Between March 2003 and June 2007, 243 patients with thoracic esophageal carcinoma underwent esophageal resection in our hospital. All the cases were divided into five groups according to tumor localization, including cervical, upper middle, middle, lower middle and lower sections. Each was then subdivided into 2 groups: with and without intraoperative thoracic duct ligation. Statistical analysis was carried out to evaluate the relevance between ligation and non-ligation of the thoracic duct during esophagectomy and the incidence of post-operative chylothorax. A total of 8 cases of post-operative chylothorax was recorded and the incidence was 3.3%. Incidence with respect to tumor location was as follows: cervical section: ligation subgroup 3 cases and non-ligation subgroup 5 cases; upper middle section: no one for both ligation and non-ligation subgroups; middle section: ligation subgroup 0/26 and non-ligation subgroup 1/28 (3.6%); lower middle section: ligation subgroup 1/39 (2.6%) and non-ligation subgroup 1/35 (2.9%); lower section: ligation subgroup 1/37 (2.7%) and non-ligation subgroup 2/44 (4.5%). Logistic regression analysis revealed no significant difference between ligation and non-ligation subgroup in the prevention of post-operative chylothorax (P>0.05). Thoracic duct ligation as preventive measure can not decrease the incidence of chylothorax secondary to esophagectomy.

Two cases of postoperative chylothorax treated with parenteral octreotide and conservative therapy

Chylothorax is a rare complication following cardiac surgery for congenital heart diseases. Although conservative management is successful in the majority of cases, surgical intervention is required in a refractory one. Recently, subcutaneous or intravenous infusion of octreotide has been used as a safe treatment that helps avoiding surgical intervention. Herein, we report two cases of postoperative chylothorax treated with parenteral octreotide and conservative therapy.

長鎖脂肪酸シンチグラフィーで診断し中鎖脂肪酸食で治癒した術後乳び胸の一例

長鎖脂肪酸シンチグラフィーで診断し中鎖脂肪酸食で治癒した術後乳び胸の一例

THREE CASES OF CHYLOTHORAX POSSIBLY CAUSED BY LEAKED CHYLE FROM THE THYMUS

We experienced 3 cases of postoperative chylothorax, which might be caused by leaked chyle from excised (or dissected) site of the thymus following cervical dissection accompanied by ligation of thoracic duct, or superior mediastinal dissection including thymus excision for advanced thyroid carcinoma or recurred breast cancer. Consideration of mechanisms of the occurrence in these 3 cases provided a speculation that ligation of the thoracic duct made the internal pressure of the duct increase, a reflux of chyle to the lymphatic pathway between the thoracic duct and thymus occurred, and finally chyle leaked from the thymus to cause chylothorax. In this manner, when thymus excision (or dissection) is performed in patients whose thoracic duct was ligated at the cirvical site, careful attitude is essential to prevent leakage of chyle before it happens.In the treatment of the disease, conservative treatments such as sustained intrathoracic drainage, nutritional management through the central vein, and internal pleurodesis led to heals for all 3 cases. Conservative treatments can be recommended for such chylothorax.

術後乳び胸９例の検討

術後乳び胸９例の検討

Experiences of postoperative chylothorax in children.

Eight cases of postoperative chylothorax in children are discussed. The age of the patients varied between 5 hours and 18 months. Chylothorax was diagnosed between 3 and 14 days after operation. In 6 cases chylothorax was certainly due to damage to the thoracic duct, or other big lymph vessels in the lungs or mediastinum. These patients had no typical pulmonary changes before chylothorax developed. In 2 cases there was probably no damage to the lymph vessels, but the venous pressure in the upper part of the body was elevated by constriction of the superior caval vein. The anatomical prerequisites for chylothorax in these cases is discussed. In these patients, before chylothorax, pulmonary changes appeared in the radiograph interpreted as widened lymph vessels and caused by altered lymph flow at the periphery. If pulmonary changes of this kind appear in patients with elevation of pressure in the superior caval vein, this may be a sign that chylothorax may develop. The importance of early diagnosis is stressed. Drainage of the pleura with continuous suction has proved to be the therapy of choice. Direct operation has not been necessary in any of our cases.