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 Postoperative Ascites of Unknown Origin following Laparoscopic Appendicectomy: An Unusual Complication of Laparoscopic Surgery

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
M. Feretis ◽  
H. Boyd-Carson ◽  
A. Karim
Keyword(s):  
Laparoscopic Surgery ◽  
Urinary Tract ◽  
Lymphatic System ◽  
Rare Complication ◽  
Unknown Origin ◽  
Causative Factor ◽  
Young Female ◽  
Laparoscopic Appendicectomy ◽  
Unusual Complication ◽  
Iatrogenic Injuries

Postoperative ascites is a very rare complication of laparoscopic surgery. Significant iatrogenic injuries to the bowel, the urinary tract, and the lymphatic system should be excluded promptly to avoid devastating results for the patient. In some cases, in spite of investigating patients extensively, no definitive causative factor for the accumulation of fluid can be identified. In such cases, idiopathic allergic or inflammatory reaction of the peritoneum may be responsible for the development of ascites. We present a case of ascites of an unknown origin in a young female patient following a laparoscopic appendicectomy.

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 Lymphatic pathway evaluation in congenital heart disease using 3D whole-heart balanced steady state free precession and T2-weighted cardiovascular magnetic resonance

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Vasu D. Gooty ◽  
Surendranath R. Veeram Reddy ◽  
Joshua S. Greer ◽  
Zachary Blair ◽  
Riad Abou Zahr ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Cardiovascular Magnetic Resonance ◽  
Steady State ◽  
Thoracic Duct ◽  
Congenital Heart ◽  
Lymphatic System ◽  
Single Ventricle ◽  
Steady State Free Precession ◽  
Free Precession ◽  
Lymphatic Pathway

Abstract Background Due to passive blood flow in palliated single ventricle, central venous pressure increases chronically, ultimately impeding lymphatic drainage. Early visualization and treatment of these malformations is essential to reduce morbidity and mortality. Cardiovascular magnetic resonance (CMR) T2-weighted lymphangiography (T2w) is used for lymphatic assessment, but its low signal-to-noise ratio may result in incomplete visualization of thoracic duct pathway. 3D-balanced steady state free precession (3D-bSSFP) is commonly used to assess congenital cardiac disease anatomy. Here, we aimed to improve diagnostic imaging of thoracic duct pathway using 3D-bSSFP. Methods Patients underwent CMR during single ventricle or central lymphatic system assessment using T2w and 3D-bSSFP. T2w parameters included 3D-turbo spin echo (TSE), TE/TR = 600/2500 ms, resolution = 1 × 1 × 1.8 mm, respiratory triggering with bellows. 3D-bSSFP parameters included electrocardiogram triggering and diaphragm navigator, 1.6 mm isotropic resolution, TE/TR = 1.8/3.6 ms. Thoracic duct was identified independently in T2w and 3D-bSSFP images, tracked completely from cisterna chyli to its drainage site, and classified based on severity of lymphatic abnormalities. Results Forty-eight patients underwent CMR, 46 of whom were included in the study. Forty-five had congenital heart disease with single ventricle physiology. Median age at CMR was 4.3 year (range 0.9–35.1 year, IQR 2.4 year), and median weight was 14.4 kg (range, 7.9–112.9 kg, IQR 5.2 kg). Single ventricle with right dominant ventricle was noted in 31 patients. Thirty-eight patients (84%) were status post bidirectional Glenn and 7 (16%) were status post Fontan anastomosis. Thoracic duct visualization was achieved in 45 patients by T2w and 3D-bSSFP. Complete tracking to drainage site was attained in 11 patients (24%) by T2w vs 25 (54%) by 3D-bSSFP and in 28 (61%) by both. Classification of lymphatics was performed in 31 patients. Conclusion Thoracic duct pathway can be visualized by 3D-bSSFP combined with T2w lymphangiography. Cardiac triggering and respiratory navigation likely help retain lymphatic signal in the retrocardiac area by 3D-bSSFP. Visualizing lymphatic system leaks is challenging on 3D-bSSFP images alone, but 3D-bSSFP offers good visualization of duct anatomy and landmark structures to help plan interventions. Together, these sequences can define abnormal lymphatic pathway following single ventricle palliative surgery, thus guiding lymphatic interventional procedures.

La Maladie de Grisel: Spontaneous Atlantoaxial Subluxation

2001 ◽  
Vol 38 (3) ◽  
pp. 268-270 ◽  
Author(s):  
M. F. Meek ◽  
R. A. E. C. Hermens ◽  
P. H. Robinson
Keyword(s):  
Oral Cavity ◽  
Neck Pain ◽  
Rare Complication ◽  
Atlantoaxial Subluxation ◽  
Unusual Complication ◽  
Additional Investigation ◽  
Grisel’S Syndrome

Objective: “La maladie de Grisel” (Grisel's syndrome) is a spontaneously occurring atlantoaxial subluxation with torticollis. We present a case of atlantoaxial subluxation occurring in a 20-year period of pharyngoplasty surgery. The occurrence of a “spontaneous” atlantoaxial subluxation after oral cavity or pharynx operations is rare. Because some neck pain and stiffness are commonly seen after these kinds of operations, we would like to draw attention to this unusual complication. Symptoms associated with a torticollis after an operation in the oral cavity or pharynx requires additional investigation to exclude this rare complication. A review of the available literature concerning etiology and treatment of la maladie de Grisel is presented.

Diagnostic difficulties in a patient with multiple sclerosis who presents with cranial nerve palsies: an unusual complication of dental work

2020 ◽  
Vol 13 (10) ◽  
pp. e232903
Author(s):  
Jennifer Cathcart ◽  
Rebecca Caitlin Johnson ◽  
Nicholas Hughes ◽  
Manish Patel
Keyword(s):  
Multiple Sclerosis ◽  
Cavernous Sinus ◽  
Sinus Thrombosis ◽  
Rare Complication ◽  
Unusual Complication ◽  
Cavernous Sinus Thrombosis ◽  
Dental Abscess ◽  
First Case ◽  
Cranial Nerve Palsies ◽  
Diagnostic Difficulties

A woman in her 60s with multiple sclerosis (MS) presented with right-sided ptosis, right sixth nerve palsy, right facial paraesthesia and signs of sepsis. She had a recent diagnosis of a dental abscess. Investigations revealed a right submasseter abscess leading to bacterial meningitis (Streptococcus intermedius) and a cavernous sinus thrombosis. She was managed in intensive care and underwent surgical drainage of the abscess. Anticoagulation for 6 months was planned. Cavernous sinus thrombosis is a very rare complication of a dental abscess, and even less frequently associated with submasseter abscesses. The case was complicated by a history of MS, to which the patient’s symptoms and signs were initially attributed to. This case highlights the diagnostic pitfalls, and aims to enhance learning around similar cases. To the best of our knowledge, this is the first case report of a masseter/submasseter abscess leading to cavernous sinus thrombosis.

Radicular Compression Due to Lumbar Intraspinal Gas Pseudocyst: Case Report

Neurosurgery ◽  
1988 ◽  
Vol 22 (4) ◽  
pp. 731-733 ◽  
Author(s):  
Bertrand Demierre ◽  
Aymen Ramadan ◽  
Hermann Hauser ◽  
Alain Reverdin ◽  
Bénédict Rilliet ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Spinal Canal ◽  
Pain Syndrome ◽  
Herniated Disc ◽  
Unique Case ◽  
Vacuum Phenomenon ◽  
Sciatic Pain ◽  
Radicular Compression

Abstract A case of sciatic pain syndrome is reported. Computed tomography showed evidence of gas in the spinal canal, and at operation a gas-filled pseudocyst was found in the spinal canal, without herniated disc. The cause of this unique case is discussed in relation to the spinal vacuum phenomenon.

A single spinal lesion arising from an intradural meningioma contiguous with an extradural lymphoma

2012 ◽  
Vol 17 (3) ◽  
pp. 263-267
Author(s):  
Pawel P. Jankowski ◽  
Lissa C. Baird ◽  
Sassan Keshavarzi ◽  
Mary E. Goolsby ◽  
William R. Taylor ◽  
...  
Keyword(s):  
Cell Lymphoma ◽  
Spinal Column ◽  
B Cell Lymphoma ◽  
Leg Pain ◽  
Sensory Loss ◽  
Resonance Imaging ◽  
Vertebral Level ◽  
Unique Case ◽  
Mr Image ◽  
Spinal Lesion

The authors describe here a unique case of contiguous, synchronous meningioma and lymphoma in the spinal column. Both tumors were present at the same vertebral level, one intradural and the other extradural. A patient presented with bilateral leg pain, acute weakness, and sensory loss in the lower extremities. Magnetic resonance imaging revealed an intradural mass at T6–7 with ambiguous boundaries relative to the thecal sac and compressing the spinal cord. The patient underwent resection of the epidural and intradural mass at T6–7. Histopathology revealed the epidural specimen to be a double-hit B-cell lymphoma and the intradural mass to be a transitional meningioma. Postoperatively, the patient did well, with an immediate return of strength and sensation. A postoperative MR image showed complete resection of the intradural mass. The authors suggest that biopsy may be prudent in patients with known systemic lymphoma presenting with a spinal lesion that has unclear boundaries relative to the thecal sac prior to commencing radiation and chemotherapy.

scholarly journals AOSpine—Spine Trauma Classification System: The Value of Modifiers: A Narrative Review With Commentary on Evolving Descriptive Principles

2019 ◽  
Vol 9 (1_suppl) ◽  
pp. 77S-88S ◽  
Author(s):  
Srikanth N. Divi ◽  
Gregory D. Schroeder ◽  
F. Cumhur Oner ◽  
Frank Kandziora ◽  
Klaus J. Schnake ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Classification System ◽  
Injury Severity ◽  
Thoracolumbar Spine ◽  
Spinal Column ◽  
Narrative Review ◽  
Patient Specific ◽  
Upper Cervical Spine ◽  
Spine Trauma ◽  
Subaxial Cervical Spine

Study Design: Narrative review. Objectives: To describe the current AOSpine Trauma Classification system for spinal trauma and highlight the value of patient-specific modifiers for facilitating communication and nuances in treatment. Methods: The classification for spine trauma previously developed by The AOSpine Knowledge Forum is reviewed and the importance of case modifiers in this system is discussed. Results: A successful classification system facilitates communication and agreement between physicians while also determining injury severity and provides guidance on prognosis and treatment. As each injury may be unique among different patients, the importance of considering patient-specific characteristics is highlighted in this review. In the current AOSpine Trauma Classification, the spinal column is divided into 4 regions: the upper cervical spine (C0-C2), subaxial cervical spine (C3-C7), thoracolumbar spine (T1-L5), and the sacral spine (S1-S5, including coccyx). Each region is classified according to a hierarchical system with increasing levels of injury or instability and represents the morphology of the injury, neurologic status, and clinical modifiers. Specifically, these clinical modifiers are denoted starting with M followed by a number. They describe unique conditions that may change treatment approach such as the presence of significant soft tissue damage, uncertainty about posterior tension band injury, or the presence of a critical disc herniation in a cervical bilateral facet dislocation. These characteristics are described in detail for each spinal region. Conclusions: Patient-specific modifiers in the AOSpine Trauma Classification highlight unique clinical characteristics for each injury and facilitate communication and treatment between surgeons.

Splenic Rupture: An Unusual Complication of Colonoscopy

2007 ◽  
Vol 73 (4) ◽  
pp. 393-396 ◽  
Author(s):  
Stefan Holubar ◽  
Amit Dwivedi ◽  
J. Eisendorfer ◽  
R. Levine ◽  
R. Strauss
Keyword(s):  
Hemorrhagic Shock ◽  
Splenic Injury ◽  
Early Recognition ◽  
Rare Complication ◽  
Treatment Options ◽  
Unusual Complication ◽  
Angiographic Embolization ◽  
Diagnostic Colonoscopy ◽  
Life Threatening ◽  
Therapeutic Colonoscopy

Splenic injury is a known, albeit rare, complication of diagnostic and therapeutic colonoscopy. Within a 6-month period, we observed two colonoscopic splenic injuries. We report these two cases of splenic injury who presented differently after colonoscopy: one presented as frank hemorrhagic shock, and the other as a subacute splenic hemorrhage with symptomatic anemia. The first patient presented with hemorrhagic shock several hours after a diagnostic colonoscopy and required an emergency splenectomy. The second patient presented with symptomatic anemia several days after a diagnostic colonoscopy and was treated by angiographic embolization. Clinical presentation and discussion of the mechanisms of injury, available treatment options, and strategies for preventing colonoscopic splenic injuries are presented. Awareness of this complication is paramount in early recognition and management of this potentially life-threatening injury.

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