Diagnosis the diagnosis of a chyle leak is often subjective, and diagnostic criteria may vary. A postoperative chylothorax was managed by nonsurgical means and subsided. Evolution of chylous fistula management campisi et al. Evolution of chylous fistula management after neck dissection. What should be avoided, however, is the failure to. Chylous fistula is a known complication in procedures such as neck dissection and aneurysm surgery.
Evidence of chyle extravasation occurs within hours after neck dissection, and is not difficult to. Chyle leak after breast augmentation aesthetic surgery. We used diet control, intravenous nutritional support, and continuous somatostatin to reduce the chylous fistula output, and hydrophilic silver ioncontaining dressings for wound coverage. Chyle from the greek word chylos, juice is a milky bodily fluid consisting of lymph and emulsified fats, or free fatty acids ffas. Conservative management of postoperative chylous fistula. Chylous ascites chyloperitoneum is a rare clinical condition, characterized by an accumulation of lymph fluid in the peritoneal cavity. A leak can occur in the lymphatic system after surgery.
However, the efficacy and safety for chylous fistulas with high outputs, which would drain more than 1 lday, have yet to be established. Chylous fistula of the neck free download as powerpoint presentation. Treatment options depend on duration and daily volume of. Octreotide in the medical management of chyle fistula. Octreotide for conservative management of intractable high. Postoperative chylous pseudocyst pdf free download. In fact, transecting the duct when carrying out radical surgery low down in the neck or the mediastinum may often be necessary. Chylous leakage post mastectomy and axillary clearance. If you continue browsing the site, you agree to the use of cookies on this website. A case report, authorfei chang and dasheng cheng and mingyuan qian and wei lu and huatao li and hongtai tang and zhaofan xia, booktitlethe american journal of case reports, year2016. It is formed in the small intestine during digestion of fatty foods, and taken up by lymph vessels specifically known as lacteals.
However chyle leak that develops after axillary dissection is a rare phenomenon. After identification of the cause of chyle leakage extravasation or obstruction, embolization of the td is performed proximally. Pdf evolution of chylous fistula management after neck dissection. To confirm that a fluid is chylous, the lipid content should be greater than. Pdf on oct 9, 2018, raffaele rauso and others published neck dissection complications. While ramos and faintuch observed superior fistula resolution with total parenteral nutrition, as against fat free nasogastric feeds, alkhayat noted satisfactory outcomes with nasogastric feeding and mct. In this study we have evaluated the incidence, possible cause, and management of chylous fistula that develops after radical breast cancer surgeries. First, coils are placed to provide a matrix for glue polymerization. Etiologically it is due to a disruption of the lymphatic system, most commonl. Chyle fistula definition of chyle fistula by medical. 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. Chylous fistula, one case of which was associated with chylothorax, appeared in three patients.
The clavicular head of the sternocleidomastoid can be dissected free and. Chylous fistula after lateral neck dissection for thyroid cancer is a rare but serious complication. Norman oneil machado department of surgery, sultan qaboos university hospital, muscat, oman. Use of octreotide for chyle fistula following neck dissection. Apr 17, 2015 chylous fistula of neck and management slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. In a retrospective study of 604 consecutive patients seeking treatment for fistula in the democratic republic of congo, 24 4% had fistula related to sexual assault. Postoperative chylous fistula after neck dissection is an uncommon. A milky appearance of the drainage fluid is often the initial clue. Three were repaired with sutures with or without fibrin sealant, 1 was repaired with a free strap muscle patch and fibrin sealant, and the final patients fistula was repaired with a free sternocleidomastoid muscle patch and. We use cookies to offer you a better experience, personalize content, tailor advertising, provide social media features, and better understand the use of our services. Management of chylous fistulas myers en, dinerman ws.
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. 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. Pdf evolution of chylous fistula management after neck. Postoperative chylous fistulas occur as a complication in 12 percent of all radical neck dissections. Chylous fistula is located at the level of the second lumbar vertebra. Total parenteral nutrition along with somatostatin can relieve the symptoms and close the fistula in patients with chylous ascites rapidly. If a leak is suspected, the anesthetist should be asked to apply a continuous posi tive airway pressure ie, valsalva maneuver to the patient. The volume and the characters of outflow material from the fistula indicate the kind of conservative treatment 56. Threewererepairedwith sutureswith or withoutfibrin sealant, 1was repaired with a free strap muscle patch andfibrin sealant, and the final patients fistula was repaired with a free sternocleidomastoid muscle patch and surgicel. We present an unusual case of a woman who developed a persistent pseudocyst and recurrent chylous ascites following acute necrotizing pancreatitis. One simple method several authors advocate is to restrict enteral fat intake. The purpose of this study is to demonstrate efficacy of tde in treating nontraumatic chylous effusions.
Prompt identification and treatment of a chyle leak are essential for. Attention is directed to the variations in the anatomical distribution of the cervical lymphatics. This maneuver increases lymthoracoscopic management of chylous fistulae 261 phatic and venous pressures, which increases flow from any chyle leak that may exist and makes it easier to identify. Thoracoscopic management of chylous fistulae sciencedirect. Pdf treatment of a chylous fistula in the neck with. Treatment of highoutput thoracic chylous fistula with transabdominal embolization of cisterna chyli. Chyle fistula is a rare but potentially devastating and morbid condition. Management of chyle leak after head and neck surgery.
Five 50% of the chylous fistulae were identified intraoperatively. Chylous ascites as a consequence of idiopathic pancreatitis. The thoracic duct is the primary structure that returns lymph and chyle from the entire left and right lower half of the body. Pdf thoracic duct chylous fistula following severe electric. Conservative management of postoperative chylous fistula with. Subsequently, an expansile mass appeared in the left side of the chest and was surgically removed.
Case report, report by european journal of therapeutics. The incidence of chyle leaks varies depending on the underlying cause. Treatment for this series could be divided into two groups. Figure 1 from thoracic duct chylous fistula following severe. Health, general esophageal cancer care and treatment fistulas homeopathy materia medica and therapeutics tetracycline tetracyclines. Thoracic duct embolization tde is an acceptable alternative procedure for treating traumatic chylothorax. Objective to study the effectiveness of octreotide in managing chyle fistula neck and its effect on duration of hospitalization. Treatment of highoutput thoracic chylous fistula with. The prompt identification of a postoperative chylous fistula and the applicability of an individually based managements protocol may help in the majority of the cases to reduce the potential morbidity, without significant longterm effects.
Chylous fistula after axillary lymph node dissection. Most commonly it is associated with abdominal malignancy usually lymphoma. Recent findings there is a paucity of literature on the treatment of lymphatic, chylous, and thoracic duct injuries following head and neck surgery. Chylous fistula following radical neck dissection is a disturbing and potentially serious complication. Chyle fistula after neck dissection for an unusual breast.
Pdf repair of chylous fistula in the neck by local musc. Medium chain triglycerides mct are absorbed into the portal circulation directly and do not contribute to chylous output. 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. Evolution of chylous fistula management after neck dissectio. Chyle fistula cf is a rare but potentially devastating and morbid complication after neck dissection. During treatment, chylous fistula developed in the left clavicular region, which we diagnosed as thoracic duct chylous fistula. When and why of etiopathogenesis and how of management. 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. An unusual treatment modality, surgical glue, was utilized to plug the fistula. Thoracoscopic management of chylous fistulae, american. Npwt appears to be a promising treatment for chylous fistula with low levels of chyle output 22.
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. Chyle extravasation can result in delayed wound healing, dehydration. Five50% of the chylous fistulae were identified in traoperatively. Chylous ascites also known as chyloperitoneum is defined as the abnormal intraperitoneal accumulation of milky lymphatic fluid with a triglyceride level 110 mgdl 1. Chylous ascites as a complication of laparoscopic donor.
Postoperative chylous pseudocyst a 59yearold man underwent resection of an aneurysm of the descending thoracic aorta with graft replacement. A slight backandforth motion during deployment encourages proper coil deployment. It appears to be an effective therapy available for the treatment of chylous ascites caused by various disorders. At the time, this condition was managed merely with pressure dressings and wound packing, and mortality rates of up to 12. The lymphatic system carries fluid, fats, protein and cells that fight infection. The most important part of the conservative management of chylous fistula is a fat free diet free of longchain fatty acids. During periods of mct formula with fat free diet, pt. 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. Repair of chylous fistula in the neck by local musc ular flaps. Sexual assault has been linked to obstetric fistula, especially in conflict settings. Repair of chylous fistula in the neck by local muscular flaps. Selfresolving nausea was encountered in 1 patient from octreotide use, and 1 patient developed a salivary fistula as a result of the chylous fistula.