1438 The Past, Present and Future Management of Complex Chyle Fistulae

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
H Temperley ◽  
C Waters ◽  
J Carey ◽  
N E Donlon ◽  
C L Donohoe ◽  
...  
Keyword(s):  
Thoracic Duct ◽  
Traditional Approach ◽  
Rare Complication ◽  
Case Series ◽  
High Volume ◽  
Acute Onset ◽  
Management Approach ◽  
Somatostatin Analogue ◽  
Chyle Leak ◽  
Cisterna Chyli

Abstract Background Chyle leak/fistula is a rare complication of oesophageal surgery, usually consequent on an unintended breach of the thoracic duct, its tributaries, or the cisterna chyli. For high volume persistent leaks further surgery has been the traditional approach, however two cases have resulted in a new management approach at this Centre. Case Series The first patient, a 49-year-old, developed high volume drain output post three stage oesophagectomy. His jejunostomy feeding was discontinued, total parenteral nutrition and a somatostatin analogue, were commenced. Despite these measures, the drain output remained >1.5litres per day and an exploratory thoracotomy was performed. The second patient, an 81-year-old underwent a transhiatal-oesophagectomy. On postoperative day 10 he developed acute onset shortness of breath, CXR demonstrated a large left sided pleural effusion. CT thorax demonstrated multiloculated complex pleural effusions. US guided pig tail drain was placed in the largest targetable effusion. The fluid was chylous in appearance. In both cases, an interventional radiological approach, not previously performed at this centre, provided definitive management. Lymphangiography was performed via injection of 1mL of Lipoidol® every 5 minutes into the inguinal lymph nodes to identify the cisterna chyli. A guidewire was advanced via the cisterna chyli with coils and glue used to embolize the leaking tracts. Discussion The lessons from this experience provide an algorithm for the management of chyle leaks, that will change practice at this centre. Embolization or disruption of thoracic duct and cisterna chyli leaks will be first line therapy for complex chyle leaks, with surgery reserved for where this fails.

scholarly journals Therapeutic Intranodal Lymphangiography for Refractory Chylous Ascites Complicating Acute Necrotic Pancreatitis

2018 ◽  
Vol 27 (2) ◽  
pp. 195-197 ◽  
Author(s):  
Thomas Jardinet ◽  
Len Verbeke ◽  
Lawrence Bonne ◽  
Geert Maleux
Keyword(s):  
Rare Complication ◽  
Chylous Ascites ◽  
Invasive Treatment ◽  
Chyle Leak ◽  
Cisterna Chyli ◽  
Severe Pancreatitis ◽  
Necrotic Pancreatitis ◽  
Chyle Leakage ◽  
First Time ◽  
Intranodal Lymphangiography

Chylous ascites is a rare complication of acute pancreatitis. However, the incidence of intraperitoneal chyle leakage related to severe pancreatitis may be much higher. This is probably the result of direct damage to the cisterna chyli or its tributaries by pancreatic enzymes. In this case, conservative treatment failed to resolve the chyle leak. For the first time, to our knowledge, ultrasound guided therapeutic intranodal lymphangiography was shown to be a successful, minimally invasive treatment option in chylous ascites complicating acute necrotic pancreatitis.

scholarly journals Femoral Head-Trunnion Dissociation in Metal-on-Polyethylene Total Hip Arthroplasty – A Unique Case Report

2018 ◽  
Vol 7 (4) ◽  
Author(s):  
Nick N. Patel ◽  
George N. Guild III ◽  
Greg A. Erens
Keyword(s):  
Risk Factors ◽  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Rare Complication ◽  
Case Series ◽  
Acute Onset ◽  
Future Research ◽  
Contributing Factors ◽  
Total Hip

Background: Gross trunnion failure (GTF) after total hip arthroplasty is a rare complication and has only been reported in a few case series. Some of the associated risk factors have been described in the literature and include larger femoral heads, greater offset, and increased BMI. Despite this, the mechanism behind GTF is poorly understood and early diagnosis and treatment continues to be challenging.Case Presentation: We present the case of complete femoral head and trunnion dissociation in a 63 year-old female nine years after total hip arthroplasty. Unique to this case is the lack of classic patient and implant risk factors for GTF along with the acute onset nearly nine years after implantation. Discussion: This case presentation highlights the fact that the contributing factors and mechanism behind GTF continue to be poorly understood. There is a need for future research to help better understand this phenomenon and to help potentially identify those at risk for GTF.

scholarly journals P34 Early-onset neutropenia in rituximab treated rheumatoid arthritis patients: a case series

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Chung Mun Alice Lin ◽  
Alice R Lorenzi ◽  
Faye A. H Cooles
Keyword(s):  
Rheumatoid Arthritis ◽  
Early Onset ◽  
Bystander Effect ◽  
Case Reports ◽  
Rare Complication ◽  
Case Series ◽  
Acute Onset ◽  
Biliary Cirrhosis ◽  
Drug Induced ◽  
Cycle Number

Abstract Background Rituximab is a chimeric monoclonal anti-CD20 antibody, used in the management of autoimmunity. It is known to have a favourable safety profile, however, a rare complication includes early-onset neutropenia (EON), defined as neutropenia having occurred within four weeks of rituximab treatment. Only eight case reports have been published so far, the majority of which relate to its use in SLE and none in rheumatoid arthritis (RA). We report here the first dedicated case series of post-rituximab EON in RA. Methods We identified 4 RA patients with EON. All were anti-citrullinated protein antibody (ACPA) and rheumatoid factor (RF) positive. Demographics were female:male ratio 3:1, with mean age 58 (range 33-69). Our first patient (65F) had a past medical history (PMH) of asymptomatic primary biliary cirrhosis (ANA+ve, AMA+ve, M2+ve), the second (65F) had Sjogren’s syndrome (ANA+ve, dsDNA+ve, IgG+ve) and the third (69F) had diverticulosis, Raynaud’s phenomenon and subacute cutaneous lupus with no systemic manifestations (ANA+ve, Ro and La +ve). The fourth patient (33M) had no PMH. Three had previously reported intermittent neutropenia on prior disease modifying anti-rheumatic drug (DMARD) therapy, but none were on DMARDs/doses known to cause this at the time of Rituximab. Standard Rituximab regimens were administered (1g with 100mg IV methylprednisolone, two weeks apart) with two patients (33M, 69F) on concurrent methotrexate (15mg) and hydroxychloroquine (200mg) respectively. Results EON occurred at 4, 11 and 14 days (n = 2) (mean 10 days) post-infusion with mean nadir 0.57x109/L (range 0.05 - 1.17x109/L). It was the first treatment cycle for two patients (65F and 33M), whilst the others (65F and 69F) had received 2-3 previous cycles uneventfully. Patient 2, 65F and ANA+ve, subsequently developed neutropenic sepsis and was treated with standard protocol and G-CSF (granulocyte-colony stimulating factor). Cultures were negative and other investigations did not identify any infective source. The other three patients’ (33M, 69F) neutropenia resolved spontaneously without required intervention. Conclusion EON is a rare but serious complication of rituximab but to date no clear mechanism has been identified. It has been suggested that EON may be due to a bystander effect of lysozyme and granzyme release, secondary to B cell killing and that individuals with a high-affinity FcγRIIIa 158 V allele are more susceptible to this mechanism and therefore prone to a greater depth of neutropenia. Because of its relative acute onset, we may actually be under-recognising uncomplicated episodes of EON due to variability in routine blood monitoring post-treatment. We therefore want to highlight the need for vigilance in this patient cohort, particularly in those who are already susceptible to drug-induced neutropenia or are ANA+ve, in addition to vigilance irrespective of cycle number. Future monitoring of early neutrophil counts in Rituximab-treated RA patients may provide additional insight into this rare complication. Disclosures C. Lin None. A.R. Lorenzi None. F.A.H. Cooles None.

Chylorrhea: a rare complication of thoracoscopic discectomy of the thoracolumbar junction

2007 ◽  
Vol 6 (6) ◽  
pp. 563-566 ◽  
Author(s):  
Amin Amini ◽  
Ronald I. Apfelbaum ◽  
Meic H. Schmidt
Keyword(s):  
Thoracic Duct ◽  
Lymphatic System ◽  
Rare Complication ◽  
Thoracolumbar Spine ◽  
Spinal Column ◽  
Herniated Disc ◽  
Unusual Complication ◽  
Unique Case ◽  
Cisterna Chyli ◽  
Lymphatic Pathway

✓The thoracic duct along with the cisterna chyli is a major lymphatic pathway near the anterior thoracolumbar spine. Despite the fragile nature of the lymphatic system and its proximity to the spinal column, chylorrhea is rarely encountered by spine surgeons. The authors present a unique case of chylorrhea associated with a left thoracoscopic, trans-diaphragmatic discectomy and fusion for a T12–L1 herniated disc. The anomalous location of the thoracic duct at the left lateral vertebral column contributes to this unusual complication.

scholarly journals A rare complication following laparoscopic cholecystectomy; a case series

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S542
Author(s):  
A.M. Schreuder ◽  
T.M. van Gulik ◽  
E.A. Rauws
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Rare Complication ◽  
Case Series

scholarly journals Case Series of Three Patients with Rifampicin-Induced Thrombocytopenia

2020 ◽  
Author(s):  
Chandramouli M.T
Keyword(s):  
Pulmonary Tuberculosis ◽  
Adverse Reactions ◽  
Rare Complication ◽  
Case Series ◽  
Tuberculosis Treatment ◽  
Effective Drug ◽  
Antitubercular Drugs ◽  
Short Course ◽  
Life Threatening

AbstractLife-threatening adverse reactions of antitubercular drugs are uncommon; however, thrombocytopenia is one such rare complication encountered with rifampicin, isoniazid, ethambutol, and pyrazinamide. Rifampicin is the most effective drug and its use in the tuberculosis treatment led to the emergence of modern and effective short-course regimens. I am reporting case series of three patients with pulmonary tuberculosis presented with rifampicin-induced thrombocytopenia.

scholarly journals Contrast-Induced Encephalopathy after Cerebral Angiogram: A Case Series and Review of Literature

2021 ◽  
pp. 405-413
Author(s):  
Cecelia Allison ◽  
Vaibhav Sharma ◽  
Jason Park ◽  
Clemens M. Schirmer ◽  
Ramin Zand
Keyword(s):  
Rare Complication ◽  
General Pattern ◽  
Treatment Protocol ◽  
Case Series ◽  
Altered Mental Status ◽  
Cortical Blindness ◽  
Neurological Deficits ◽  
Cerebral Angiogram ◽  
Iodinated Contrast Medium ◽  
Iodinated Contrast

Contrast-induced encephalopathy (CIE) is a rare complication that arises from exposure to iodinated contrast medium and can result in a range of symptoms, including cortical blindness, aphasia, focal neurological deficits, and altered mental status. We present 4 individual cases of CIE who presented with stroke-mimic symptoms following surgery with localized iodixanol or ioversol injection. We outline a clinical timeline of all patients, showing that CIE follows a general pattern of delayed onset, worsening symptomology, and ultimately full recovery. All patients received IV hydration, corticosteroids, or both as part of their treatment protocol.

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