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Strama KL, Rice TD, Ruff JP, Carter KE, Ernst NE, Kuebel DJ, Droege ME. Octreotide Dosing in the Medical Management of Chyle Leak Following Otolaryngologic, Thoracic, and Trauma Surgery: A 9-Year Evaluation. J Pharm Pract 2022. [DOI: 10.1177/08971900221125831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Chyle leak is a rare complication following otolaryngologic, thoracic, and trauma surgery wherein the thoracic duct is transected. Case reports and small case series describe octreotide for the medical management of chyle leak, but limited data exist to determine the ideal dose. Objective: To evaluate octreotide dosing in patients with acute chyle leak. Methods: This retrospective, single center, cohort study evaluated adult patients admitted to the otolaryngology, cardiothoracic, and trauma surgery teams over a 9-year period. Patients diagnosed with a chyle leak who received octreotide were eligible for inclusion. Groups were defined as successful medical management or failure requiring definitive surgery. The primary endpoint was daily octreotide dose between groups. Results: Forty-seven patients were included with 29 (61.7%) admitted to the otolaryngology service and 44 (93.6%) with surgical complication as the chyle leak cause. Thirty-two (68.1%) patients had successful medical management while 15 (31.9%) patients failed and required surgical intervention. There was no difference in median daily octreotide dose (250 [IQR, 170-288] µg vs 253 [IQR, 200-282] µg, P = .9). Octreotide weight-based dose, treatment duration, and route of administration were similar between groups. Daily drain output and complete bowel rest were significantly higher in the failure group. Daily drain output was identified as an independent risk factor for failure. Conclusion: Octreotide dose was similar in patients with and without successful medical management of chyle leak. Future studies are needed to determine optimal octreotide dosing and elucidate the relationship between octreotide, drain output, and surgical intervention need.
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Affiliation(s)
- Kelly L. Strama
- Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
- Department of Pharmacy Services, UC Health – University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Timothy D. Rice
- Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
- Department of Pharmacy Services, UC Health – University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Jacob P. Ruff
- Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
| | - Kristen E. Carter
- Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
- Department of Pharmacy Services, UC Health – University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Neil E. Ernst
- Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
- Department of Pharmacy Services, UC Health – University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Dalton J. Kuebel
- Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
- Department of Pharmacy Services, UC Health – University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Molly E. Droege
- Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
- Department of Pharmacy Services, UC Health – University of Cincinnati Medical Center, Cincinnati, OH, USA
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Dar PMUD, Gamanagatti S, Priyadarshini P, Kumar S. Traumatic chylothorax: a dilemma to surgeons and interventionists. BMJ Case Rep 2021; 14:14/5/e238961. [PMID: 34020985 DOI: 10.1136/bcr-2020-238961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Chylothorax is generally seen due to iatrogenic injury to the thoracic duct during thoracic or neck surgery. It can also be encountered secondary to chest trauma either blunt or penetrating. Percutaneous thoracic duct embolisation is an alternative to surgical treatment and is considered an effective and safe minimally invasive treatment option for chylothorax with a success rate of about 80%. We present a case of blunt trauma to the chest with chylothorax, which was successfully managed with transvenous retrograde thoracic duct embolisation.
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Affiliation(s)
- Parvez Mohi Ud Din Dar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Shivanand Gamanagatti
- Radiodiagnosis, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Pratyusha Priyadarshini
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Subodh Kumar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Mazhar K, Mohamed S, Patel AJ, Berger-Veith S, Abid Q, Ghosh S. Delayed chylothorax in the absence of radiological evidence of rib or vertebral body fractures following blunt trauma. J Surg Case Rep 2021; 2021:rjab112. [PMID: 33854762 PMCID: PMC8024043 DOI: 10.1093/jscr/rjab112] [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: 02/16/2021] [Accepted: 03/08/2021] [Indexed: 11/14/2022] Open
Abstract
Our case report illustrates effective implementation of conservative measures without the need for more invasive procedures, which can be required in refractory cases. Our patient was a 42-year-old female who fell from a horse and presented with a 1-week history of dyspnoea. Investigations revealed her to have a large right chylothorax, which was treated conservatively with chest drainage and octreotide. The patient remained in hospital for a total of 3 days prior to being discharged home without further complications. Blunt traumatic chylothorax should be considered as part of the differential diagnosis in patients who present with ongoing dyspnoea or chest discomfort within a 2-week preceding history of blunt trauma. Radiological imaging should be mandatory and the absence of posterior thoracic fractures does not exclude the diagnosis. Conservative management with pleural drainage, medium-chain triglyceride diet and octreotide yielded excellent results in our case.
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Affiliation(s)
- Khurum Mazhar
- Department of Thoracic Surgery, Royal Stoke University Hospital, Stoke-on-Trent ST4 6QG, UK
| | - Saifullah Mohamed
- Department of Thoracic Surgery, Royal Stoke University Hospital, Stoke-on-Trent ST4 6QG, UK
| | - Akshay Jatin Patel
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | | | - Qamar Abid
- Department of Thoracic Surgery, Royal Stoke University Hospital, Stoke-on-Trent ST4 6QG, UK
| | - Shilajit Ghosh
- Department of Thoracic Surgery, Royal Stoke University Hospital, Stoke-on-Trent ST4 6QG, UK
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Chylothorax caused by blunt chest trauma: a review of literature. Indian J Thorac Cardiovasc Surg 2020; 36:619-624. [PMID: 33100622 DOI: 10.1007/s12055-019-00904-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/25/2019] [Accepted: 11/07/2019] [Indexed: 10/24/2022] Open
Abstract
Chylothorax is the accumulation of chyle in the pleural cavity that typically contains a high concentration of triglycerides. Blunt chest trauma is a rare cause. The aim of this study is to review all of the reported cases of chylothorax caused by blunt chest trauma. Available databases were explored systematically for the condition and the eligible papers were included. The literature search revealed 30 studies with 39 cases, 72.3% of the cases were male, and 21.7% of the patients were female. The age range varied between 4 and 75 years with a mean age of 35.8 years. All of the patients were diagnosed after fluid sampling from the pleural fluid by thoracentesis and/or chest tube insertion. About 71.4% of the patients were treated successfully by conservative management: others (28.6%) were managed surgically. Although it is a rare condition, persistent milky drainage after blunt chest trauma should raise the suspicion of chylothorax. Pleural fluid sampling is the cornerstone of the diagnosis. In the majority of the cases, conservative treatment is quite enough. Surgery is indicated whenever non-operative measures failed.
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Abstract
Isolated thoracic duct injury is an uncommon clinical event and is rare in the setting of trauma. We describe a case of an isolated thoracic duct injury resulting in the development of bilateral chylothorax following a motor vehicle collision in the absence of any other definable injury. We outline the initial patient presentation and diagnosis. After failing a trial of conservative management the patient underwent lymphangiography followed by thoracic duct ligation with pleurodesis. This case highlights the importance of recognizing thoracic duct injury following trauma.
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Affiliation(s)
- Shelby Champion
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Daniele Wiseman
- Department of Medical Imaging, London Health Science Centre, London, Ontario, Canada
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Wallace WA, Benjamin Christie D. Early Operative Ligation in the Management of Bilateral Chylothoraces After Blunt Thoracic Injury. Am Surg 2020; 88:308-309. [PMID: 32776787 DOI: 10.1177/0003134820942148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- William A Wallace
- Department of Surgery, Mercer University School of Medicine, The Medical Center Navicent Health, Macon, GA, USA
| | - D Benjamin Christie
- Department of Surgery, Mercer University School of Medicine, The Medical Center Navicent Health, Macon, GA, USA
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Lee H, Han SH, Lee MK, Kwon OS, Kim KH, Kim JS, Chon SH, Shinn SH. Bilateral Chylothorax Due to Blunt Spine Hyperextension Injury: A Case Report. JOURNAL OF TRAUMA AND INJURY 2019. [DOI: 10.20408/jti.2018.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hohyoung Lee
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Sung Ho Han
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Min Koo Lee
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Oh Sang Kwon
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Kyoung Hwan Kim
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Jung Suk Kim
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Soon-Ho Chon
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Sung Ho Shinn
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
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