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