Life threatening presentation of thoracic duct injury post thyroid surgery; a case report

Prolonged iatrogenic thoracic duct chylous fistula in Neck Surgery: conservative management or surgery? A Literature review

BACKGROUND

Thoracic duct chylous fistula is a rare complication following neck surgery, especially for malignant disease. Despite its low incidence, it can be a life-threatening postoperative complication increasing the risk of infection, bleeding, hypovolemia, electrolyte imbalance, and malnutrition. Currently, the management of thoracic duct fistula is not standardized yet. It can range from conservative to surgical approaches, and even when surgery indication occurs, there is no unanimous agreement on timing and operative steps, so the surgical approach still remains mostly subjective, in accordance with clinical conditions of the patients and with surgeon's experience.

AIMS

The aim of the study was to search into Literature a common accepted behaviour in thoracic duct chylous fistula occurring.

METHODS

A literature review was carried out. Conservative treatments include fasting associated with total parental nutrition or low-fat diet, compressive dressings, and octreotide administration. If conservative treatment fails, in order to avoid dangerous consequences, functional repair of the thoracic duct injury with lymphovenous microanastomosis should be the preferred solution, rather than an approach that obliterates the thoracic duct or lymphatic-chylous pathways, such as thoracic duct embolization, therapeutic lymphangiography, and thoracic duct ligation.

CONCLUSIONS

In our experience, patients undergone thyroidectomy and neck dissection for thyroid-differentiated cancer, who report an unrecognized thoracic duct chylous fistula after surgery, must be treated via integrated conservative and surgical treatment. A literature review about thoracic duct chylous fistula following neck surgery, focusing on the current management and therapeutic approach, was furthermore carried out, in order to delineate the actual therapeutic options in case of thoracic duct chylous fistula occurrence.

Thoracic Duct Embolization in Post-neck Dissection Chylous Leakage: A Case Series of Six Patients and Review of the Literature

Chylous leak is a serious complication of neck dissection. Patients are often managed conservatively, and failure of conservative management necessitates surgical management, which adds to their morbidity. We present a case series demonstrating the value of thoracic duct embolization (TDE) in management of patients with chylous leaks following neck dissection who have failed conservative management and to review the literature on this specific application of TDE. Between 2011 and 2019, six patients underwent a total of seven TDE procedures. Lymphatic leak was identified, and clinical success was achieved in all patients, with one patient requiring repeat TDE. No minor or major complications were reported. In conclusion, TDE is a safe and effective tool in management of chylous leaks following neck dissection.