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Deo KB, Deo SK, Gautam S, Pandit N, Adhikary S. Laparoscopic transhiatal en-mass thoracic duct ligation for persistent bilateral spontaneous Chylothorax: A case report. Clin Case Rep 2024; 12:e8618. [PMID: 38455853 PMCID: PMC10918701 DOI: 10.1002/ccr3.8618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Abstract
Chylothorax is a rare entity associated with morbidity. Surgical thoracic duct ligation (TDL) by thoracoscopic approach is the recommended choice for persistent chylothorax. However, thoracoscopy is not feasible in case of previous pleurodesis. We describe a successful laparoscopic transhiatal en-mass TDL in a 61-year-old lady for persistent spontaneous chylothorax after failed optimal conservative management and three sessions of pleurodesis. The study shows that laparoscopic transhiatal thoracic duct ligation is an effective alternative in a case where thoracoscopy is not feasible due to various reasons.
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Affiliation(s)
- Kunal Bikram Deo
- Department of Gastrointestinal SurgeryB P Koirala Institute of Health SciencesDharanNepal
| | - Sumit Kumar Deo
- Department of Gastrointestinal SurgeryB P Koirala Institute of Health SciencesDharanNepal
| | - Sujan Gautam
- Department of Gastrointestinal SurgeryB P Koirala Institute of Health SciencesDharanNepal
| | - Narendra Pandit
- Department of Gastrointestinal SurgeryB P Koirala Institute of Health SciencesDharanNepal
- Department of SurgeryBirat Medical College and Teaching HospitalBiratnagarNepal
| | - Shailesh Adhikary
- Department of Gastrointestinal SurgeryB P Koirala Institute of Health SciencesDharanNepal
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Ahn S, Lee H, Kang JK, Kim IS, Moon Y, Choi JS, Won YD, Jeong SC, Choi SY. Intractable chylous leak after radical esophagectomy treated with radiotherapy. J Cardiothorac Surg 2023; 18:325. [PMID: 37964362 PMCID: PMC10647089 DOI: 10.1186/s13019-023-02419-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 11/03/2023] [Indexed: 11/16/2023] Open
Abstract
Postoperative chylous leak after esophagectomy is a rare but potentially life-threatening complication that results in hypovolemia, electrolyte imbalance, malnutrition, and immunologic deficiency. However, the management of postoperative chylous leak remains controversial. Following a diagnosis of esophageal cancer, a 64-year-old man was treated by video-assisted thoracoscopic esophagectomy, laparoscopic gastric tube formation, prophylactically thoracic duct ligation, and reconstruction with esophagogastrostomy at the neck level. Massive postoperative drainage from the thorax and abdomen did not initially meet the diagnostic criteria for chylothorax, which was ultimately diagnosed 3 weeks after the operation. Despite various treatments including total parenteral nutrition, octreotide and midodrine, reoperation (thoracic duct ligation and mechanical pleurodesis), and thoracic duct embolization, the chylous leak persisted. Finally, low-dose radiation therapy was administered with a daily dose of 2 Gy and completed at a total dose of 14 Gy. After this, the amount of pleural effusion gradually decreased over 2 weeks, and the last drainage tube was removed. The patient was alive and well at 60 months postoperatively. Herein, we describe a patient with intractable chylous leak after esophagectomy, which persisted despite conservative treatment, thoracic duct ligation, and embolization, but was finally successfully treated with radiotherapy.
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Affiliation(s)
- Seha Ahn
- Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Heejin Lee
- Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Joon Kyu Kang
- Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - In Sub Kim
- Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Youngkyu Moon
- Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Jung Suk Choi
- Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Yoo Dong Won
- Department of Radiology, College of Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Seong Cheol Jeong
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Si Young Choi
- Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea.
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Muacevic A, Adler JR, Jordan KG, Waters JK, Reznik SI. "Mega" Cisterna Chyli: A Case Report and Review of the Literature. Cureus 2023; 15:e34111. [PMID: 36843809 PMCID: PMC9946758 DOI: 10.7759/cureus.34111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 01/25/2023] Open
Abstract
Enlarged cisterna chyli is an infrequently encountered entity and is most often an asymptomatic, incidental finding on imaging for other reasons. The pathogenesis of cisterna chyli enlargement is not well elucidated and includes infectious, inflammatory, and idiopathic causes. In this report, we present the rare case of an asymptomatic, markedly dilated "mega" cisterna chyli in a 60-year-old female.
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Jacob S, Ali M, El-Sayed Ahmed MM, Itkin M, Narula T, Pham S, Erasmus D. Refractory chylous effusions in lymphangioleiomyomatosis patient post lung transplant. SAGE Open Med Case Rep 2020; 8:2050313X20921332. [PMID: 32477564 PMCID: PMC7233883 DOI: 10.1177/2050313x20921332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 04/01/2020] [Indexed: 11/17/2022] Open
Abstract
Lymphangioleiomyomatosis is a rare systemic disorder of unknown etiology that affects young women almost exclusively. Chylous effusions are known to be associated with lymphangioleiomyomatosis and may be difficult to treat. We present the case of a 37-year-old female who received bilateral lung transplantation for lymphangioleiomyomatosis complicated by refractory chylothorax and chylous ascites, ultimately controlled through repeated, open surgical procedures and percutaneous lymphatic embolization interventions. The combined surgical and interventional radiological approach, while not novel in their own right, suggests that a multi-modal interventional approach may be required in refractory cases.
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Affiliation(s)
- Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Mojahid Ali
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Maxim Itkin
- Center for Lymphatic Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tathagat Narula
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Si Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - David Erasmus
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
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Nicastri DG, Flores RM. Chylothorax: Abdominal approach. J Thorac Cardiovasc Surg 2017; 155:814. [PMID: 29106894 DOI: 10.1016/j.jtcvs.2017.09.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Daniel G Nicastri
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY
| | - Raja M Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY.
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