A postoperative chylothorax was managed by nonsurgical means and subsided. Chylous fistula following radical neck dissection is a disturbing and potentially serious complication. Most of the highoutput fistulas require a long time of conservative treatment. It is formed in the small intestine during digestion of fatty foods, and taken up by lymph vessels specifically known as lacteals. Chyle leak following cervical surgery has a reported incidence of around 2% annually. Early diagnosis and treatment is important to reduce morbidity and mortality. Chyle leak, although rare, is a welldocumented complication following surgical dissection of the neck. Chylothorax is an uncommon complication of chylous fistula and may be seen on chest radiographs as a pleural effusion. Octreotide acetate is a somatostatin analogue established in the treatment of chylothorax. Management ranges from drainage and simple dietary modifications to thoracic duct ligation, as well as treating the primary process. If detected postoperatively, however, management of a lowoutput fistula through conservative measures including dietary changes, somatostatin analogues. Chest radiographs in patients with chylous fistula can demonstrate a softdensity opacity at the root of the neck.
Chylous fistula is an uncommon but challenging complication after lymphadenectomy for treatment of gynecologic cancers. Novel management of intractable cervical chylous fistula with. Cervical chylous fistula is an uncommon complication after neck dissection, but it might lead to some serious clinical outcomes. It may impair nutrition, compromise and delay wound healing, and prolong hospitalization. Postoperative chylous fistula after neck dissection is an uncommon. Postoperative chylous fistula after neck dissection is an uncommon complication associated with significant patient morbidity. The purpose of this study is to demonstrate efficacy of tde in treating nontraumatic chylous effusions. Chylous fistula of the neck free download as powerpoint presentation.
Spontaneous closure of a chylous fistula is usual, but the rare intractable fistula may lead to disastrous nutritional and immunological consequences. Introduction damaging or cutting a thoracic duct while operating low on the left side of the neck does not occur infrequently, even in experienced hands. Novel management of intractable cervical chylous fistula. The use of somatostatin analogue is well documented as a treatment for. Chylous fistulas were confirmed by axillary white fluid and were unrelated to obesity, surgical method or the area of axillary lymph node dissection. What should be avoided, however, is the failure to. These complications can delay the start of adjuvant therapy. Chylous fistula following surgical lumbar sympathectomy. Chylous leakage post mastectomy and axillary clearance. Chylous fistula is a serious complication of neck surgery. One patient had an output of 1,800 ml24 hour at the time of chylous fistula diagnosis on postoperative day 1. Diagnosis the diagnosis of a chyle leak is often subjective, and diagnostic criteria may vary. An unusual treatment modality, surgical glue, was utilized to plug the fistula.
Chylous fistula following axillary lymphadenectomy. Chylous fistula prevention and management thawley 1980. Presentation as a postoperative lymphocele is rare. Chylous ascites chyloperitoneum is a rare clinical condition, characterized by an accumulation of lymph fluid in the peritoneal cavity.
In patients with thoracic chylous effusions, the anatomy of the central lymphatic system and lymphatic abnormalities were reliably viewed at interstitial transpedal mr lymphangiography. Flow from the chylous fistula will cease with obliteration of the pleuromediastinal space. Chylous ascites as a consequence of idiopathic pancreatitis. Chylous fistula following axillary lymphadenectomy cirugia. With persistent chylothorax, the second factor is probably the more important. We encountered four chylous fistula cases after breast cancer operations out of a total of 851 cases, all of which involved the left breast. Repair of chylous fistula in the neck by local musc ular flaps. Chylous fistula, one case of which was associated with chylothorax, appeared in three patients. Conservative and surgical management strategies for high and lowoutput lymph fistulas are inconsistent. The terms chyle and fistule can be confusing and the condition chyle fistula is often termed a leaky lymphatic vessel. Its occurrence is so uncommon that most physicians have not cared for patients with a chylothorax. Treatment options include dietary modifications or surgical intervention.
The age at presentation ranged from i to 80 median 12 years. Meticulous surgical technique in the areas of the thoracic duct on the left and the lymphatic ducts on the right will usually prevent the occurrence of a chylous leak. Thoracic duct embolization for nontraumatic chylous effusion. Recognizing and managing a chylous fistula intraop eratively is the most effective approach to management. Chylous fistula is a rare complication of axillary lymph node dissection, with some 10 cases having been described in the literature. Minimally invasive management of chylous fistula after. Although the majority of cf is reported on the left side, the right thoracic duct can also be injured with an incidence of 825% of all cf.
It includes axillary drains on continuous suction, pressure dressings, bed rest, and nutritional modifications. Surgical treatment for chylous ascites included resection of retroperitoneal. Its presence contributes substantially to increased morbidity and may retard the onset of adjuvant therapies. Management of chyle leak after head and neck surgery. Pdf evolution of chylous fistula management after neck.
Jun 01, 2007 chylous fistula is an uncommon yet serious complication after esophagectomy. Chylous fistulas in cases treated surgically for breast cancer only, are rare. Chylous pericardial effusion after pulmonary lobectomy. The most usual complications are seroma, chronic lymphoedema, and sensitive alterations on the inner arm. To confirm that a fluid is chylous, the lipid content should be greater than. Chylous fistula is an uncommon yet serious complication after esophagectomy. This condition has a predilection for the left side of the neck, but up to 25% of cases involve the right side of the neck. Nov 29, 2007 chyle fistula is defined as a leakage of lymphatic fluid from the lymphatic vessels, typically accumulating in the thoracic or abdominal cavities, but occasionally manifesting as an external fistula.
Conservative treatment was unsuccessful, and the surgical oncology team then. After identification of the cause of chyle leakage extravasation or obstruction, embolization of the td is performed proximally. Chyle leak following axillary lymph node clearance is a rare yet important complication. Chylous ascites and highoutput chylous fistula are rare complications following abdominal or pelvic surgery. Lymphoscintigraphy examination indicated that a chylous fistula was present in the plane of the tracheal carina. Chyle fistula is a rare but serious complication following neck dissection with an incidence ranging from 1% to 2. Thoracic duct injury due to left subclavicular vein catheterization. Chyle fistula after neck dissection for an unusual breast. Sep 03, 2019 chyle fistula is defined as a leakage of lymphatic fluid from the lymphatic vessels, typically accumulating in the thoracic or abdominal cavities but occasionally manifesting as an external fistula. Pdf repair of chylous fistula in the neck by local musc. Chylous fistula is a known complication in procedures such as neck dissection and aneurysm surgery.
Fistula is an abnormal tubelike passage between two points within the body or with one point on the skin surface. Chyle leakearly enteral feedingpancreatic resection. Chyle fistula is a potentially devastating phenomenon that results from violation of the thoracic duct or right lymphatic duct in the neck, most commonly during radical neck dissection. Chyle extravasation can result in delayed wound healing, dehydration. Treatment options depend on duration and daily volume of. No factor was a significant predictor for success of conservative medical management of a chylous fistula.
Chylous fistula after axillary lymph node dissection. During treatment, chylous fistula developed in the left clavicular region, which we diagnosed as thoracic duct chylous fistula. This usually occurs due to trauma and rupture of the lymphatics or increased peritoneal lymphatic pressure secondary to obstruction. First, coils are placed to provide a matrix for glue polymerization. Reliable criteria to predict outcome of conservative versus surgical treatment in clinically evident lymph fistula are. Chyle leak formation is an uncommon but serious sequela of head and neck surgery when the thoracic duct is inadvertently injured, particularly with the resection of malignancy low in the neck. Treatment options are explored and the patient was treated successfully with non operative management. Laparoscopic approach for correction of chylous fistula after. After failure to control the chylous effusion with conservative medical treatment, the patient underwent videoassisted thoracic surgery through the left chest for thoracic duct ligation and pericardial fenestration. Objective to study the effectiveness of octreotide in managing chyle fistula neck and its effect on duration of hospitalization.
Pdf evolution of chylous fistula management after neck dissection. Treatment of a chylous fistula in the neck with thoracic duct. Treatment of symptomatic primary chylous disorders sciencedirect. Chylothorax is an accumulation of fluid, rich in triglycerides and characterized by the presence of chylomicrons, in the pleural space. Conservative therapy failing, the 5 patients underwent 6 ligations of the thoracic duct. It appears to be an effective therapy available for the treatment of chylous. The aim of this study was to analyse the incidence, treatment and evolution of chylous fistula in neck dissection. Download fulltext pdf download fulltext pdf chylous fistula following surgical lumbar sympathectomy article pdf available in ejves extra 16. Management of intraoperative chyle leak during neck. Chyle fistula in advanced and metastatic thyroid cancer background.
Postoperative scenarios may include chylous fistula, chylothorax, chylomediastinum, chylopericardium, lymphocele, persistent lymphorrhea, and secondary lymphedema. Conventional management includes drainage, nutritional modification, or aggressive surgical interventions such as thoracic duct ligation, flap coverage, fibrin glue, or talc pleurodesis. Conservative management of postoperative chylous fistula. Chyle from the greek word chylos, juice is a milky bodily fluid consisting of lymph and emulsified fats, or free fatty acids ffas. However chyle leak that develops after axillary dissection is a rare phenomenon. Axillary chylous fistula is a complication with an incidence of less than 0. Management of chylous fistula as a complication of neck.
These are more common on the left but 25% of cervical chylous fistulas are right sided. Pdf treatment of a chylous fistula in the neck with. Evidence of chyle extravasation occurs within hours after neck dissection, and is not difficult to. Chyle leakage and early enteral feeding following pancreatico. The incidence of chyle leaks varies depending on the underlying cause. Management of chylous fistulas myers en, dinerman ws. Conservative treatment may be employed for a duration of up to 48 h and continued if the fistula produces an output of pdf access article on wiley online library html view download pdf for offline viewing. The development of postoperative leaks of the thoracic duct after neck dissection or vascular surgery of the subclavian and vertebral artery is a well known but rare complication. The treatment of postoperative chyle fistula still remains unclear. Surgical intervention in a complicated persistent chyle leak. In all cases initial treatment consisted of conservative management with total parenteral nutrition, and clear oral fluids. The underlying etiologies for ca have been classified as traumatic, congenital, infectious, neoplastic, postoperative, cirrhotic or.
There is a paucity of literature on the treatment of lymphatic, chylous, and thoracic duct injuries following head and neck surgery. Article information, pdf download for novel management of intractable cervical. Usually, an injury of the duct manifests immediately after the operation with chylous drainage. We used diet control, intravenous nutritional support, and continuous somatostatin to reduce the chylous fistula output, and hydrophilic silver ioncontaining dressings for wound coverage. The thoracic duct is the primary structure that returns lymph and chyle from the entire left and right lower half of the body.
Prompt identification and treatment of a chyle leak are essential for optimal surgical outcome. This uncontrolled extravasation of chyle arise from damage to the thoracic duct, which transports triglycerides and cholesterol from intestinal lymphatics into the venous system 2. Most commonly it is associated with abdominal malignancy usually lymphoma. Management of chylous fistula as a complication of neck dissection. Repair of chylous fistula in the neck by local muscular flaps. The lipids in the chyle are colloidally suspended in chylomicrons. Use of octreotide for chyle fistula following neck dissection. In this study we have evaluated the incidence, possible cause, and management of chylous fistula that develops after radical breast cancer surgeries. Chylous ascites ca is a rare form of ascites that results from the leakage of lipidrich lymph into the peritoneal cavity. Attention is directed to the variations in the anatomical distribution of the cervical lymphatics. It appears to be an effective therapy available for the treatment of chylous ascites caused by various disorders. Read thoracoscopic management of chylous fistulae, american journal of otolaryngology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Chyle fistula is a rare but potentially devastating and morbid condition. Chylous fistula and a new conservative management find, read and cite all the research you need on researchgate.
Pdf thoracic duct chylous fistula following severe. Operative treatment may be an option, but identification of the leak. Pdf on oct 9, 2018, raffaele rauso and others published neck dissection complications. Chyle fistula cf is a rare but potentially devastating and morbid complication after neck dissection.
Postoperative lymphatic leakage following thyroid surgery represents a management problem with considerate potential morbidity, psychological, and economical impact. The incidence following 442 transthoracic procedures was 02 per cent p chylous fistula occurring after a three. To date, reports of the rate of this complication have ranged between 1% and 2. Pdf chylous fistula following surgical lumbar sympathectomy. Aetiology and treatment of chylous ascites browse 1992. Four cases of chylous fistula after breast cancer resection. Subsequently, an expansile mass appeared in the left side of the chest and was surgically removed. Meticulous surgical technique in the areas of the thoracic duct on the left and the lymphatic ducts on the right will usually prevent the occurrence of a chylous. Conservative treatment may be employed for a duration of up to 48 h and continued if the fistula produces an output of chylous fistulas in cases treated surgically for breast cancer only, are rare. Conservative management of postoperative chylous fistula with. Thoracic duct embolization tde is an acceptable alternative procedure for treating traumatic chylothorax. We report a series of five cases that occurred after pelvic lymph node dissection for urological cancer, in addition to their clinical. Contrastenhanced interstitial transpedal mr lymphangiography. Get your full text copy in pdf american journal of case reports.
When and why of etiopathogenesis and how of management. Evolution of chylous fistula management after neck. Chyle fistula in advanced and metastatic thyroid cancer. Chylous fistula post neck dissection is a rare and at times difficult to. A slight backandforth motion during deployment encourages proper coil deployment.
Treatment of a postoperative cervical chylous lymphocele by. Evolution of chylous fistula management after neck dissection. Mar 24, 2020 in patients with thoracic chylous effusions, the anatomy of the central lymphatic system and lymphatic abnormalities were reliably viewed at interstitial transpedal mr lymphangiography. One can theorize that this must be due to a different anatomical drainage of the right subclavian duct into the respective. Postoperative chylous pseudocyst a 59yearold man underwent resection of an aneurysm of the descending thoracic aorta with graft replacement. Total parenteral nutrition along with somatostatin can relieve the symptoms and close the fistula in patients with chylous ascites rapidly.
Chylous fistula after lateral neck dissection for thyroid cancer is a rare but serious complication. Chylous fistula following radical neck dissection is a disturbing and. We report the surgical management of 5 patients with intractable fistulas with daily drainage averaging 2,060 ml. We present an unusual case of a woman who developed a persistent pseudocyst and recurrent chylous ascites following acute necrotizing pancreatitis. In fact, transecting the duct when carrying out radical surgery low down in the neck or the mediastinum may often be necessary. Postoperative chylous pseudocyst pdf free download. Management of lymph fistulas in thyroid surgery springerlink.
Selfresolving nausea was encountered in 1 patient from octreotide use, and 1 patient developed a salivary fistula as a result of the chylous fistula. Thoracoscopic management of chylous fistulae, american. Octreotide in the medical management of chyle fistula. Although most cervical chylous fistulas can heal in a few d. Chylous fistula is an infrequent complication of head and neck surgery, with an incidence reported in % of patients undergoing major neck surgery. Pdf chylous ascites and highoutput chylous fistula. A thoracic duct injury complicated with a chylous fistula is a rather rare. Supradiaphragmatic ligation of the thoracic duct in. Thoracic duct injury is a rare but serious complication following surgery of the neck or chest that leads to uncontrolled chyle leak. Cutoff values for chylous leak are triglycerides over 1. If you continue browsing the site, you agree to the use of cookies on this website. Download citation novel management of intractable cervical chylous fistula with local application of pseudomonas aeruginosa injection cervical chylous fistula is an uncommon complication after. Conservative management is the first line of treatment.
Apr 17, 2015 chylous fistula of neck and management slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Chyle fistula cf is a rare but challenging condition for the surgeon and the patients health. The incidence in 95 transhiatal resections was 105 per cent. We present a case report of a chylous fistula after. The patient had a long history of type 2 diabetes mellitus. Chyle is the milky fluid containing fats and lymph which travel through the lymphatic vessels. Although most cervical chylous fistulas can heal in a few days with standard treatments, some can be intractable.
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