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Al Jaaly E, Baig K, Patni R, Anderson J, Haskard DO. Surgical management of chylopericardium and chylothorax in a patient with Behçet's disease. Clin Exp Rheumatol 2011; 29:S68-S70. [PMID: 21968240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 09/15/2011] [Indexed: 05/31/2023]
Abstract
Behçet's syndrome is a chronic multisystem inflammatory disease characterised classically by recurrent oral and genital ulcers with ocular lesions. It can affect blood vessels of all sizes, but involves veins more commonly than arterie. The presence of chylothorax in Behçet's syndrome is rare, with only a few cases cited in the literature. The most likely pathogenesis is SVC thrombosis with obstruction of the orifice of the thoracic duct resulting in leakage of chyle from the pleural lymphatics into the pleural space. The majority of the previously reported cases were managed medically without surgical intervention. We believe that this report describes the first use of surgery to ligate the thoracic duct and create a pericardial window in a Behçet's syndrome with chylothorax and chylopericardium.
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77
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Lai FC, Chen L, Tu YR, Lin M, Li X. Prevention of chylothorax complicating extensive esophageal resection by mass ligation of thoracic duct: a random control study. Ann Thorac Surg 2011; 91:1770-4. [PMID: 21536248 DOI: 10.1016/j.athoracsur.2011.02.070] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 02/19/2011] [Accepted: 02/22/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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%). CONCLUSIONS 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.
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78
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Mundra V, Savage EB, Novaro GM, Asher CR. Delayed chylous pericardial effusion after aortic valve replacement. Tex Heart Inst J 2011; 38:431-432. [PMID: 21841877 PMCID: PMC3147199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Chylopericardium after cardiac surgery is rare, and there are few reports of its occurrence after aortic valve surgery. Chylous pericardial effusion 4 months after aortic valve replacement for endocarditis is highly unusual.Herein, we report the case of a 54-year-old man who had undergone bioprosthetic aortic valve replacement because of endocarditis and valvular dysfunction. Two months later, he underwent pericardiocentesis twice because of large pericardial effusions consisting of pinkish white fluid with predominant lymphocytes. Four months after valve replacement, he presented with recurrent effusion consistent with early tamponade, and a pericardial window was created. At surgery, 1,500 cc of milky white fluid was recovered, and the diagnosis of chylopericardium was made. Postoperative high-volume drainage prompted thoracic duct ligation, which was curative.
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79
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Matsuda E, Okabe K, Yamamoto H, Tao H, Kobayashi S, Hirazawa K, Sugi K. [Pericardial cyst that involved thoracic duct]. KYOBU GEKA. THE JAPANESE JOURNAL OF THORACIC SURGERY 2010; 63:470-473. [PMID: 20533739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A 79-year-old man was admitted to our hospital because of swallowing disturbance. Chest X-ray and computed tomography (CT) scan revealed 7 x 6 cm cystic shadow in posterior mediastinum. We diagnosed that swallowing disturbance caused by pericardial cyst. Cysticotmy was performed. Three days after operation, chylothorax occurred. Conservative therapy was not effective, we performed re-operation 28 days later from the 1st operation. There was aperture of thoracic duct inside of cyst, and thoracic duct was ligated. After the 2nd operation, chylothorax was cured.
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80
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Migliori C, Boroni G, Milianti S, Ekema G. [Chylothorax]. Minerva Pediatr 2010; 62:89-91. [PMID: 21090078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Chylothorax is the accumulation of chyle in the pleural space. In newborns the congenital form is often prenatal diagnosed, while the late variety originates to damage to the thoracic duct by cardiac surgery, diaphragmatic hernia, etc. Clinical presentation results from the accumulation of pleural fluid and the symptoms depends on the size of the effusion. The treatment needs both medical and surgical care. The pleural cavity should be drained via thoracocentesis, and total parenteral nutrition should be started. Afterward fat-free diet with the addition of medium-chain triglycerides could be initiate. Somatostatin and octreotide have been successfully employed, mainly in post-surgery chylothorax. Surgery should be considered when medical management fails. Some approaches are reported, and thoracic duct ligation, pleurodesis and pleuroperitoneal shunts are the most utilized. The prognosis of chylothorax depends on the etiology, and it is consequence of a variety of treatments that may influence the outcome.
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81
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Achildi O, Smith BP, Grewal H. Thoracoscopic ligation of the thoracic duct in a child with spontaneous chylothorax. J Laparoendosc Adv Surg Tech A 2009; 16:546-9. [PMID: 17004888 DOI: 10.1089/lap.2006.16.546] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We report a case of a 2-year old girl with a spontaneous chylothorax who presented with respiratory distress. The management of this condition, which included thoracic duct ligation using a thoracoscopic technique, is discussed, and we review the literature on chylothorax.
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82
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Sugi K, Minamiya Y. [Thoracic duct ligation in chylothorax]. KYOBU GEKA. THE JAPANESE JOURNAL OF THORACIC SURGERY 2009; 62:964-965. [PMID: 19943375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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83
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Ravnskov U, Dahlback O, Messeter L. Treatment of glomerulonephritis with drainage of the thoracic duct and plasmapheresis. ACTA MEDICA SCANDINAVICA 2009; 202:489-94. [PMID: 596249 DOI: 10.1111/j.0954-6820.1977.tb16870.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Nine patients with various types of severe glomerulonephritis were treated with drainage of the thoracic duct (n=8) and/or plasmapheresis (n=6) without the use of pharmacological immunosuppression. In most of the patients treatment produced a prompt temporary regression of albuminuria and creatininemia. In one patient renal function was substantially improved 8 months after the last period of treatment, in 2 patients the progress of the uremia was probably retarded. In the remaining 6 patients treatment had no obvious effect on the course of the illness. Drainage of the thoracic duct and plasmapheresis may be of benefit in the treatment of glomerulonephritis, but their proper utilization requires further studies.
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84
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Melduni RM, Oh JK, Bunch TJ, Sinak LJ, Gloviczki P. Reconstruction of occluded thoracic duct for treatment of chylopericardium: a novel surgical therapy. J Vasc Surg 2009; 48:1600-2. [PMID: 19118743 DOI: 10.1016/j.jvs.2008.06.066] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 06/24/2008] [Accepted: 06/25/2008] [Indexed: 11/18/2022]
Abstract
Chylopericardium is an uncommon disease predominantly caused by trauma. Prolonged chyle depletion may result in nutritional, metabolic, and immunologic deficiencies due to loss of essential proteins, immunoglobulins, fat, vitamins, electrolytes, and water. Medical treatment includes a low-fat diet with medium-chain triglyceride restriction, cardiac support, diuretic medications, and drainage of the pericardial effusion. Conventional surgical therapy consists of pericardial fenestration and thoracic duct ligation. We report a case of massive secondary chylous pericardial effusion successfully treated with microsurgical lymphovenous anastomosis, reconnecting the occluded thoracic duct to the internal jugular vein. This case highlights features and management strategies of this perplexing clinical condition.
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85
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Carobbi B, White RAS, Romanelli G. Treatment of idiopathic chylothorax in 14 dogs by ligation of the thoracic duct and partial pericardiectomy. Vet Rec 2008; 163:743-745. [PMID: 19103616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The outcome and complications associated with thoracic duct ligation combined with partial pericardiectomy in 14 dogs with idiopathic chylothorax were investigated retrospectively. Nine of the dogs were treated in the uk and five in Italy. All of them were reassessed clinically four weeks after surgery and the respiratory function and any pleural fluid accumulation were evaluated; they were followed up by telephone contact for at least six months. Eleven of the dogs were clinically normal and had no radiographic signs of pleural effusion when reassessed after four weeks. Two showed radiographic signs of a minor accumulation of pleural fluid but were clinically normal; when reassessed after three months they showed similar radiographic signs and clinical findings; but after four months there was no evidence of pleural effusion. One dog had a major complication that required a second surgical intervention.
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86
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Priego Jiménez P, Collado Guirao MV, Rojo Blanco R, Grajal Marino R, Rodríguez Velasco G, García Villanueva A. Chyle fistula in right cervical area after thyroid surgery. Clin Transl Oncol 2008; 10:593-6. [PMID: 18796379 DOI: 10.1007/s12094-008-0257-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thoracic duct injury is an infrequent (1-2.5%) but severe complication after neck surgery, leading to nutritional, metabolic and immunologic deficiencies. We report a case of a 34-year-old woman with a right thoracic duct injury after surgery of a thyroid medullar cancer effectively treated with conservative management (parenteral nutrition and intravenous somatostatin). Optimal treatment of these patients is unclear, without a clear limit between conservative and surgical treatment.
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87
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Andreieshchev SA, Miasoiedov SD, Bul'ba MV, Driuk MF, Chernukha LM, Vakhnenko LM. [Surgical treatment of persisting chylothorax]. KLINICHNA KHIRURHIIA 2008:5-9. [PMID: 19278039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Results of surgical treatment of 8 patients, suffering chylothorax, persisting during 1-14 months are presented. The desease have appeared also resistant to complex conservative treatment trial. This kind of treatment was conducted with simultaneous intensive preoperative preparation, surgical intervention consisted of open thoracotomy with thoracic duct suturing and ligature. The operative treatment had appeared primarily ultimately successful in 5 (62.5%) patients, and after postoperative pleurodesis conduction--in 3 (37.5%). One week of intensive conservative therapy trial with simultaneous preoperative preparation and subsequent shift to surgical intervention constitutes an optimal tactical principle in the persisting chylothorax treatment.
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88
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Narita Y, Naoki K, Hida N, Okamoto H, Kunikane H, Omori T, Kase M, Watanabe K. [Case of bilateral chylothorax with systemic lupus erythematosus complicated by steroid-/immunosuppressant-resistant pleural effusion]. NIHON KOKYUKI GAKKAI ZASSHI = THE JOURNAL OF THE JAPANESE RESPIRATORY SOCIETY 2008; 46:120-125. [PMID: 18318255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 20-year-old woman, with systemic lupus erythmatosus complicated by steroid-and immunosuppressant-resistant bilateral pleural effusion, was admitted to the emergency room because of dyspnea and fever. Chest Xray film revealed bilateral massive pleural effusion. Bilateral thoracocentesis yielded fluid with chyle. Conservative treatment including intravenous hyper-alimentation and continuous drainage were performed but with no remarkable improvement. She underwent thoracoscopy-aided ligation of the thoracic duct. After the operation, bilateral pleurodesis was performed by intrathoracic injection of OK-432, because of uncontrolled pleural effusion. There have been no signs of recurrence at 10 months in this case of SLE with steroid-and immunosuppressant-resistant pleural effusion.
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89
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Lu JJ, Hou BP, Yao D, Zhang W, Qin CW, Ma J, Luo HH, Zhong FT. [Effect of thoracic duct ligation during transthoracic esophagectomy on the prevention of post-operative chylothorax in different tumor locations]. ZHONGHUA WEI CHANG WAI KE ZA ZHI = CHINESE JOURNAL OF GASTROINTESTINAL SURGERY 2008; 11:36-38. [PMID: 18197491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To investigate the effect of thoracic duct ligation during transthoracic esophagectomy on preventing post-operative chylothorax in different tumor locations. METHODS 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. RESULTS 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). CONCLUSION Thoracic duct ligation as preventive measure can not decrease the incidence of chylothorax secondary to esophagectomy.
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90
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Gomez J, Palacios E, Gupta JD. Post-traumatic cervical chyloma. EAR, NOSE & THROAT JOURNAL 2008; 87:12-14. [PMID: 18357936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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91
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Inomoto Y, Hirose H, Fukahori S, Tsuchida T, Kawano T, Fukushima C, Matsuse H, Matsuo N, Kohno S. [Case of idiopathic chylothorax successfully treated with surgical ligation of thoracic ducts]. NIHON KOKYUKI GAKKAI ZASSHI = THE JOURNAL OF THE JAPANESE RESPIRATORY SOCIETY 2007; 45:804-807. [PMID: 18018631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A 72-year-old woman visited a clinic for anorexia and general fatigue but no particular abnormality was detected by routine examination at that time. Thereafter, she experienced gradually increasing dyspnea and chest X ray showed right pleural effusion. Idiopathic chylothorax was diagnosed due to the milky effusion with a high concentration of triglyceride (2618 mg/dl) and no apparent causative disease. Irrespective of treatments including dietary restriction, drainage of the pleural space, and somatostatin injections, her effusion did not reduce. The leakage of lymph fluid from the right posterior mediastinum was identified by lymphatic scintigraphy and she was successfully treated with surgical ligation of the thoracic ducts.
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92
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Raguse JD, Pfitzmann R, Bier J, Klein M. Lower-extremity lymphedema following neck dissection – an uncommon complication after cervical ligation of the thoracic duct. Oral Oncol 2007; 43:835-7. [PMID: 17418615 DOI: 10.1016/j.oraloncology.2007.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 01/25/2007] [Indexed: 12/21/2022]
Abstract
Thoracic duct injuries and chylous fistula are well-known complications of neck dissection, occurring in 1-2% of cases. Management of these injuries can be conservative or operative. Conservative treatment consists of fat restricted diet or total parenteral nutrition reducing the volume of chyle production. Operative management includes exploration of the neck or if necessary open thoracotomy to ligate the thoracic duct. Following cervical thoracic duct ligation only few complications like chylothorax or chylous ascites are described in the literature. To the best authors knowledge, this is the first report in the english literature describing lower-extremity lymphedema following cervical thoracic duct ligation.
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93
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Chanoit G, Ferré PJ, Lefebvre HP. Chronic lymphatico-venous bypass: surgical technique and aftercare in a porcine model. Interact Cardiovasc Thorac Surg 2007; 6:705-7. [PMID: 17716995 DOI: 10.1510/icvts.2007.157867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe a chronic model of lymphatico-venous bypass in pigs with emphasis to surgical considerations, major per- and postoperative complications. A catheter (silicone or heparin coated polyurethane) was inserted in the thoracic duct of nine pigs via a right intercostal thoracotomy. A second catheter was surgically inserted in the jugular vein and the bypass was secured on the back of the animals. Pigs were monitored for capnography, end-tidal carbon dioxide, systolic, diastolic and mean blood pressure, heart rate, and rectal temperature. Apnea was recorded in every pig in the recovery period leading to one death. During the postoperative period, ventricular tachycardia in 2/9 pigs and hypothermia in 5/9 pigs were recorded. Bypass was effective in 5/9 pigs. Clotting occurred only with silicone catheters (1/2) but not with heparin-coated catheters. In the heparin-coated catheters group, bypass was patent up to 15 days with no major complication recorded. Sampling of lymph was allowed from 2 to 15 days. The immediate postoperative period is critical and should be carefully monitored. Although complications were present, the surgical technique was efficient. Chronic catheterization of thoracic duct is useful in biomedical research in the fields of intensive care, gastro-enterology, pharmacokinetic and hematology studies.
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94
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Moon H, Lee YJ, Lee SI, Yoo WH. Chylothorax and chylopericardium as the initial clinical manifestation of Behcet’s disease. Rheumatol Int 2007; 28:375-7. [PMID: 17674002 DOI: 10.1007/s00296-007-0426-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 07/11/2007] [Indexed: 10/23/2022]
Abstract
Behcet's disease (BD) is a chronic relapsing systemic vasculitic disorder affecting the arteries, veins, and vessels of any size. Large vein thrombosis in BD is not commonly developed and most commonly observed in the veins in the lower extremities and inferior or superior vena cava. In this report, a 18-year-old male patient with large vein thrombosis involving superior vena cava was presented. He was treated due to chylothorax and chylopericardium with SVC syndrome before diagnosis of BD. SVC thrombosis complicated by chylothorax and chyolpericardium can be a rare presenting initial symptom of BD.
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Abstract
Chyle leak is an unwelcome complication of esophagectomy that is associated with a high mortality. The diagnosis of this condition may be difficult or delayed and requires a high index of suspicion. Management varies from conservative treatment with drainage, intravenous nutrition, treatment and prevention of septic complications, to re-operation, either by thoracotomy or laparotomy to control the fistula. To reduce the mortality, early surgical intervention is advised and a minimally invasive approach has recently been reported in several cases. From June 2002 through August 2005 we have used video-assisted thoracoscopic surgery to diagnose and treat chyle fistulas from 6/129 (5%) patients who underwent esophagectomy for resectable carcinoma of the esophagus or high-grade dysplasia. The fistula was successfully controlled in 5/6 cases by direct thoracoscopic application of a suture, clips or fibrin glue. One patient required a laparotomy and ligation of the cysterna chyli after thoracoscopy failed to identify an intrathoracic source of the leak. An early minimally invasive approach can be safely and effectively applied to the diagnosis and management of post-esophagectomy chylous fistula in the majority of cases. Open surgery may be appropriate where minimally invasive approaches fail or where the availability of such skills is limited.
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96
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Tsukahara K, Kawabata K, Mitani H, Yoshimoto S, Sugitani I, Yonekawa H, Beppu T, Fukushima H, Sasaki T. Three cases of bilateral chylothorax developing after neck dissection. Auris Nasus Larynx 2007; 34:573-6. [PMID: 17466474 DOI: 10.1016/j.anl.2007.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Revised: 02/27/2007] [Accepted: 03/16/2007] [Indexed: 11/26/2022]
Abstract
Only 16 cases of bilateral chylothorax following neck dissection have been reported within 10 decades. In this paper, three cases of bilateral chylothorax which developed after neck dissection are reported. In all cases, conservative treatment resulted in resolution of the condition. Diagnosis may be delayed in those who are on total parenteral nutrition, and therefore particular attention should be paid to those patients. It may be difficult to treat cases of chylothorax that develop following neck dissection performed after radiotherapy.
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97
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Cho DG, Cho KD, Jo MS. Thoracoscopic direct suture repair of thoracic duct injury after thoracoscopic mediastinal surgery. Surg Laparosc Endosc Percutan Tech 2007; 17:60-1. [PMID: 17318061 DOI: 10.1097/01.sle.0000213749.38643.f3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Iatrogenic chylothorax is an uncommon thoracic duct injury, but well-known and serious complication after thoracic surgeries. Recently, video-assisted thoracoscopic surgery has been applied in the management of postoperative chylothorax and could be indicated earlier. We report herein a case of postoperative chylothorax managed successfully by early thoracoscopic direct suture repair of the site of chylous leak that developed after the thoracoscopic resection of mediastinal mass and surrounding fat with ectopic thymus in a patient with persistent myasthenia gravis with non-Hodgkin lymphoma.
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98
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Schumacher G, Weidemann H, Langrehr JM, Jonas S, Mittler J, Jacob D, Schmidt SC, Spinelli A, Pratschke J, Pfitzmann R, Alekseev D, Neuhaus P. Transabdominal ligation of the thoracic duct as treatment of choice for postoperative chylothorax after esophagectomy. Dis Esophagus 2007; 20:19-23. [PMID: 17227305 DOI: 10.1111/j.1442-2050.2007.00636.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Postoperative chylothorax after injury of the thoracic duct during esophagectomy is a rare but severe complication which may lead to serious problems such as loss of fat and proteins, and immunodeficiency. Without treatment mortality can rise to over 50%. From 1988 to 2005, we treated 10 patients with postoperative chylothorax after 409 resections of the esophagus (2.4%). Of these 10 patients nine underwent transthoracic esophagectomy with gastric pull-up to enable an intrathoracic (n = 7) or cervical (n = 2) anastomosis and one patient received a transhiatal esophagectomy with gastric pull-up and cervical anastomosis. The average amount of postoperative chylus was 2205 mL (200-4500 mL) per day. After a median postoperative interval of 10 days, relaparotomy and transhiatal double ligation of the thoracic duct was performed in nine out of 10 patients. One patient could be managed conservatively. The average amount of chylus was reduced to 151 mL per day (90.5%). Seven patients had no complications, and three suffered from postoperative pneumonia. Two of the patients with pneumonia recovered, and one died. Discharge from hospital, after ligation of the thoracic duct, was possible after a median time of 18 days (11-52). Ligation of the thoracic duct via relaparotomy appeared to be a simple and safe method to treat postoperative chylothorax.
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Khelif K, Maassarani F, Dassonville M, Laet MHD. Thoracoscopic Thoracic Duct Sealing with LigaSure in Two Children with Refractory Postoperative Chylothorax. J Laparoendosc Adv Surg Tech A 2007; 17:137-9. [PMID: 17362192 DOI: 10.1089/lap.2006.0537] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Chylothorax is an uncommon complication of cardiac surgery. We report two cases of the thoracoscopic management of persistent postoperative chylothorax by thoracic duct thermofusion and section with the LigaSure device. MATERIALS AND METHODS A 6-year-old boy and a 3-year-old girl developed persistent chylothorax following an aortic coarctation repair and a Fontan procedure, respectively. The former presented with a left chylothorax due to direct surgical injury, and the latter, a right chylothorax due to indirect lymphatic rupture secondary to increased venous pressure. In both patients, voluminous chylous drainage persisted for more than 3 weeks despite maximal medical treatment. Ultimately, a right thoracoscopic coagulation and section of the thoracic duct with the 5-mm LigaSure device was performed. The LigaSure is a computer-controlled bipolar diathermy system designed to seal blood vessels up to 7 mm in diameter, with no specific recommendations regarding the lymphatics. RESULTS The lymph leakage ceased within 2 days in the first patient and immediately in the second one, with no recurrence after oral intake resumption on day 5. Both patients are free of recurrence at 1 year. CONCLUSION Thoracoscopic coagulation and section of the thoracic duct above the diaphragm with the LigaSure device appears to be a simple, effective, and safe therapeutic option for treatment of refractory postoperative chylothorax in children.
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100
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Qureshi SS, Chaturvedi P. A novel technique of management of high output chyle leak after neck dissection. J Surg Oncol 2007; 96:176-7. [PMID: 17372924 DOI: 10.1002/jso.20763] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The occurrence of postoperative chyle leak after neck dissection or vascular surgery of the subclavian and vertebral artery is a well-known but rare complication. The management of chyle leak ranges from utilizing a myriad of conservative procedures to surgical exploration. Occasionally on surgical exploration the chyle leak is diffuse and ligation of the bed of thoracic duct is not adroit to stopping the chyle leak. We describe a technique, which will be useful in this circumstance and in recurrent chyle leak after a previous exploration.
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