scholarly journals Sarcoidosis with secondary recurrent right-sided chylothorax and chylous ascites in a Caucasian male patient

2021 ◽  
Vol 2021 (10) ◽  
Author(s):  
Sujaay Hari Jagannathan ◽  
Caleb M Winn ◽  
Arun P Nayar ◽  
Ghassan J Koussa ◽  
Carol A Brenner
Keyword(s):  
Thoracic Duct ◽  
Mediastinal Lymph Node ◽  
Chylous Ascites ◽  
Lymph Node Biopsy ◽  
Surgical Trauma ◽  
Surgical Interventions ◽  
Caucasian Male ◽  
Fluid Analysis ◽  
Thoracic Duct Ligation ◽  
Duct Ligation

ABSTRACT Sarcoidosis is a rare multisystem autoimmune disease characterized by the presence of non-caseating granulomas in involved organs. We report a novel case of a 61-year-old Caucasian male with sarcoidosis presenting with recurrent chylothorax and chylous ascites. Pleural and ascitic fluid analysis revealed high triglyceride levels, consistent with chylothorax and chylous ascites, respectively. Common etiologies of chylous fluid such as thoracic duct surgical trauma, malignancy and infection were all excluded. Sarcoidosis was confirmed by the presence of non-caseating granulomas on a mediastinal lymph node biopsy. Conservative treatment with low-fat diet, prednisone, octreotide and multiple thoracenteses failed to effectively resolve the chylothorax. Surgical interventions with pleurodesis and thoracic duct ligation were performed, leading to the complete resolution of the chylous effusion and ascites.

scholarly journals A Case Report on the Management of Intractable Chyle Leakage after Left Neck Level V Lymph Node Biopsy

2021 ◽  
Vol 64 (2) ◽  
pp. 124-128
Author(s):  
Somi Ryu ◽  
Byeong Min Lee ◽  
Seongjun Won ◽  
Jung Je Park
Keyword(s):  
Lymph Node ◽  
Thoracic Duct ◽  
Somatostatin Analogues ◽  
Lymph Node Biopsy ◽  
Nutritional Limitation ◽  
Node Biopsy ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Left Neck ◽  
Chyle Leakage

Chyle leakage from the neck, which usually occurs after iatrogenic injury of the thoracic or lymphatic duct, is an uncommon complication of head and neck surgeries, which include neck dissection or thyroidectomy. A small amount of chyle leakage can be treated with conservative approaches, such as nutritional limitation, somatostatin analogues, and wound compression. However, massive or uncontrolled chyle leakage requires surgical exploration of the wound and thoracic duct ligation via the chest or transabdominal thoracic duct embolization can be applied. Here, we report a case of intractable massive chyle leakage in a 78-year-old male after a left neck level V lymph node biopsy, which was not controlled after conservative management and explorative surgery. Various treatment approaches were attempted and successful management of chyle leakage was ultimately achieved by thoracic duct embolization.

Peritoneoatrial Shunting for Intractable Chylous Ascites Complicating Thoracic Duct Ligation

2009 ◽  
Vol 87 (5) ◽  
pp. 1601-1603 ◽  
Author(s):  
Françoise Le Pimpec-Barthes ◽  
Minh Pham ◽  
Jérome Jouan ◽  
Alain Bel ◽  
Jean-Noël Fabiani ◽  
...  
Keyword(s):  
Thoracic Duct ◽  
Chylous Ascites ◽  
Thoracic Duct Ligation ◽  
Duct Ligation

Thoracic duct injury after decortication of lung, new technique to repair thoracic duct in this challenging situation: A case report

2021 ◽  
pp. 021849232199708
Author(s):  
Nandkishore Kapadia ◽  
Saumya Sekhar Jenasamant ◽  
Ganesh Sohan Singh Rawat ◽  
Shailesh Kamkhedkar ◽  
Pratik Shah ◽  
...  
Keyword(s):  
Thoracic Duct ◽  
Left Lung ◽  
Lower Lobe ◽  
Late Complications ◽  
Patch Repair ◽  
Double Lumen Tube ◽  
Complex Case ◽  
Thoracic Duct Injury ◽  
Thoracic Duct Ligation ◽  
Duct Ligation

Background Chylothorax is a rare form of pleural effusion that can be associated with both traumatic and non-traumatic causes. Very few patients respond to conservative line of therapy. Thoracic duct ligation is often the treatment of choice in post-surgical patients; however, the optimal treatment of this disease process after traumatic injury remains unclear. Case presentation: We present the case of a 46-year-old woman with thoracic duct injury secondary to decortication for post-pneumonic empyema. Conservative therapy and pleurodesis done twice failed. She developed severe cachexia losing 15 kg in 30 days. She was referred to our center for ligation of thoracic duct. Preoperative lymphangiography located the duct injury in upper part of mediastinum. Computerized tomography scan of chest showed collapse of left lower lobe and thickened left pleura, indicating a significant pericardial effusion. She underwent decortication of left lung, pericardial window, and native pericardial patch repair of thoracic duct. Results and Conclusions: In this unusual and complex case, successful resolution of the chyle leak was achieved with new surgical technique of patch repair. The patient recovered well and was now on a normal diet. She has put on 12 kg in four months. We have avoided late complications of thoracic duct ligation by this technique. This nouvelle technique may be recommended as it is simple and effective. Ligation of thoracic duct carries late complications. Isolating right lung by double lumen tube may cause severe hypoxia as left-sided lung is not expanded as in this case.

665 PROPHYLACTIC THORACIC DUCT OBSTRUCTION DURING ESOPHAGECTOMY: THE IMPACT ON PERIOPERATIVE RISKS AND LONG-TERM SURVIVAL. A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Clara Santos ◽  
Laura Santos ◽  
Leticia Datrino ◽  
Guilherme Tavares ◽  
Luca Tristão ◽  
...  
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Postoperative Complications ◽  
Thoracic Duct ◽  
Meta Analysis ◽  
Term Survival ◽  
Long Term Survival ◽  
Thoracic Duct Ligation ◽  
Duct Ligation

Abstract   During esophagectomy for cancer, there is no consensus if prophylactic thoracic duct ligation (TDL), with or without thoracic duct resection (TDR), could influence the perioperative outcomes and long-term survival. This systematic review and meta-analysis compared patients who went through esophagectomy associated or not to ligation or resection of the thoracic duct. Methods A systematic review was conducted in PubMed, Embase, Cochrane Library Central and Lilacs (BVS). The inclusion criteria were: (1) studies that compare thoracic duct ligation, with or without resection, and non-thoracic duct ligation; (2) involve adult patients with esophageal cancer; (3) articles that analyses the outcomes—perioperative complications, perioperative mortality, chylothorax development and overall survival; (4) only clinical trials and cohort were accepted. A 95% confidence interval (CI) was used, and random-effects model was performed. Results Fifteen articles were selected, comprising 6,249 patients. TDL did not reduce the risk for chylothorax (Risk difference [RD]: -0.01; 95%CI: −0.02, 0.00). Also, TDL did not influence the risk for complications (RD: -0.02; 95%CI: −0.11, 0.07); mortality (RD: 0.00; 95%CI: −0.00, 0.00); and reoperation rate (RD: -0.01; 95%CI: −0.02, 0.00). TDR was associated with higher risk for postoperative complications (RD: 0.1; 95%CI 0.00, 0.19); chylothorax (RD: 0.02; 95%CI 0.00, 0.03). Both TDL and TDR did not influence the overall survival rate (TDL: HR: 1.17; 95%CI: 0.86, 1.48; and TDR: HR: 1.16; 95%CI: 0.8, 1.51). Conclusion Thoracic duct obliteration with or without its resection during esophagectomy does not change long term survival. Nonetheless, TDR increased the risk for postoperative complications and chylothorax.

scholarly journals Diaphragmatic fenestration an effective treatment for refractory postoperative chylothorax: a case report

2020 ◽  
Vol 8 (2) ◽  
pp. 767
Author(s):  
Oluwaseun R. Akanbi ◽  
Swaminathan Vaidyanathan ◽  
Prakash Agarwal ◽  
Janeel Musthafa ◽  
Neville A. G. Solomon
Keyword(s):  
Thoracic Duct ◽  
Medium Chain Triglyceride ◽  
Cystic Lymphangioma ◽  
Satisfactory Outcome ◽  
Thoracic Duct Ligation ◽  
Risk Of Mortality ◽  
Duct Ligation ◽  
Surgical Options ◽  
Polytetrafluoroethylene Patch ◽  
Substantial Morbidity

Postoperative chylothorax remains a clinical challenge to the surgeon with substantial morbidity and risk of mortality. Though an uncommon complication, it is known to complicate cardiac and non-cardiac thoracic surgeries. Conservative measures are first employed in managing this. Surgical options are adopted when the effusion is protracted, most recent of which includes diaphragmatic fenestration. A 9-year-old girl is presented who developed recurrent right chylothorax following thoracoscopic excision of a cystic lymphangioma. Following failed conservative therapy, she had thoracic duct ligation and right diaphragmatic fenestration (using fenestrated polytetrafluoroethylene patch) with satisfactory outcome. Aetio-pathologic mechanisms implicated in postoperative chylothorax have been classified into traumatic (iatrogenic injury to the thoracic duct or its branches) and non-traumatic. With initial conservative measures (repeated pleural aspirations and intercostal drainage, medium chain triglyceride/ low fat feeds or alternatively, fasting and total parenteral nutrition) spontaneous closure remains unpredictable. Diaphragmatic fenestration when employed resulted in faster resolution of effusion and earlier commencement of enteral feeding with no significant complication. Diaphragmatic fenestration is effective and safe for treating refractory post-operative chylothorax.

Uniportal video-assisted thoracoscopic surgery right thoracic duct ligation

ASVIDE ◽  
2021 ◽  
Vol 8 ◽  
pp. 056-056
Author(s):  
Pei Fern Koh ◽  
Narasimman Sathiamurthy ◽  
Nguk Chai Diong ◽  
Benedict Dharmaraj
Keyword(s):  
Thoracic Duct ◽  
Thoracoscopic Surgery ◽  
Video Assisted ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Video Assisted Thoracoscopic Surgery

Laparoscopic Transhiatal Thoracic Duct Ligation for Chylothorax after Esophagectomy

2019 ◽  
Vol 67 (07) ◽  
pp. 606-609 ◽  
Author(s):  
Yukinori Yamagata ◽  
Kazuyuki Saito ◽  
Kosuke Hirano ◽  
Masatoshi Oya
Keyword(s):  
Esophageal Cancer ◽  
Conservative Treatment ◽  
Thoracic Duct ◽  
Thoracic Cavity ◽  
Transthoracic Approach ◽  
Thoracic Esophageal Cancer ◽  
Transhiatal Approach ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Laparoscopic Transhiatal Approach

AbstractIn esophagectomy for thoracic esophageal cancer, chylothorax may develop at a certain frequency. For chylothorax, conservative treatment is selected first, but if it is not improved, thoracic duct (TD) ligation is considered. In general, transthoracic approach is chosen to reach the TD. However, it is sometimes difficult to identify the TD due to adhesion in the thoracic cavity. Hence, we selected a laparoscopic transhiatal approach to the TD. We introduce the procedure of our laparoscopic transhiatal TD ligation technique.

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