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PubMed1988

Chylothorax as a complication of aortocoronary bypass. Two case reports and a review of the literature.

Iatrogenic chylothorax is a well-recognized complication following thoracic surgery, but is a rare occurrence after aortocoronary bypass. Only two cases have been previously reported. Two additional cases from our hospital are presented. All four male patients responded to conservative management within two weeks of initiation of treatment. Only 12 cases of chylothorax following median sternotomy have been reported (nine women and three men). Five of the nine women required surgical exploration after a course of unsuccessful management ranging from 14 to 26 days. The cause of the chylothorax was considered to be injury to lymphatic collaterals in the anterior mediastinum, which resulted in a retrograde chyle flow; the main duct remained intact. This article reviews the normal anatomy of the thoracic duct and variations of chylothorax, and describes the mechanism of injury in aortocoronary bypass, the prevention of this complication, and the results of treatment.

Aged↗
PubMed1993

Thoracic duct cyst of the mediastinum. Case report.

A mediastinal thoracic duct cyst was incidentally found in an asymptomatic 45-year-old man. The cyst, 6 cm in diameter, was soft and unilocular, with an extremely thin wall, and contained chyle. It was successfully excised.

Humans↗
PubMed1998

Thoracic duct injury during anterior cervical discectomy: a rare complication. Case report.

Chylous fistula resulting from intraoperative injury to the cervical thoracic duct is well described as a complication of neck dissection. However, injury to the thoracic duct during spinal surgery is rarely reported. The authors present the first case of thoracic duct injury occurring during cervical discectomy and fusion via an anterior approach. The anomalous location of the terminal arch of the thoracic duct in this patient contributed to the complication. The morbidity of chyle leakage is minimized by its early recognition, a thorough understanding of lymphatic system anatomy, and aggressive management of the thoracic duct injury.

Adult↗
PubMed1999

A pathologic study of abdominal lymphangiomas.

Abdominal lymphangiomas are uncommon angiomatous tumor occurring mainly in childhood. This is a retrospective clinicopathologic study of 17 cases of abdominal lymphangioma. The patients included are five children and 12 adults, with a mean age at initial presentation of 30.7 years (age ranges 3-63). The locations of the tumors were mesentery (5), retroperitoneum (4), colon (3), omentum (3), mesocolon (1) and gallbladder (1). Infiltrative growth was more common pattern than entirely circumscribed pattern. Masses were mostly multilocular cysts and contained chyle or serous fluid. On immunohistochemical staining, 16 cases were reactive for either CD31 or factor VIII-related antigen. These fact would suggest that intra-abdominal lymphangiomas simulate the immunohistochemical features of collecting lymphatics. Follow up was possible in 12 cases for 3-50 months (mean 19 months) and only one patient showed local recurrence. Although abdominal lymphangiomas are rare in adulthood and correct preoperative diagnosis is difficult, awareness of such a possibility in adulthood will contribute to make a correct preoperative diagnosis.

Abdominal Neoplasms↗
PubMed2004

Chylous ascites: treated with total parenteral nutrition and somatostatin.

AIM: To determine the effects of total parenteral nutrition and somatostatin on patients with chylous ascites. METHODS: Five patients were diagnosed with chylous ascites on the basis of laboratory findings of ascites sample from Nov 1999 to May 2003. Total parenteral nutrition and somatostatin or its analogue was administered to 4 patients, while the other one only received total parenteral nutrition. All the patients had persistent peritoneal drainage, with the quantity and quality of drainage fluid observed daily. Necessary supportive treatments were given to the patients individually during the therapy. RESULTS: Two of 4 patients who received somatostatin therapy obtained complete recovery within 10 d without any recurrence while on a normal diet. In these 2 patients, the peritoneal drainage reduced to zero in one and the other's decreased from 2,000 mL to 80 mL with a clear appearance and negative qualitative analysis of chyle. Recurrent chylous ascites, though relieved effectively by the same method every time, developed in one patient with advanced pancreatic cancer. The other patient's lymphatic fistula was blocked with the fibrin glue after conservative treatment. The patient who only received total parenteral nutrition was cured 24 d after therapy. CONCLUSION: Total parenteral nutrition along with somatostatin can relieve the symptoms and close the fistula in patients with chylous ascites rapidly. It appears to be an effective therapy available for the treatment of chylous ascites caused by various disorders.

Adult↗
PubMed2006

Spontaneous chylous peritonitis mimicking acute appendicitis: a case report and review of literature.

Acute abdominal pain with signs and symptoms of peritonitis due to sudden extravasation of chyle into the peritoneal cavity is a rare condition that is often mistaken for other disease processes. The diagnosis is rarely suspected preoperatively. We report a case of spontaneous chylous peritonitis that presented with typical symptoms of acute appendicitis such as intermittent fever and epigastric pain radiating to the lower right abdominal quadrant before admission.

Abdomen, Acute↗
PubMed2003

Alterations of intestinal mucosa structure and barrier function following traumatic brain injury in rats.

AIM: Gastrointestinal dysfunction is a common complication in patients with traumatic brain injury (TBI). However, the effect of traumatic brain injury on intestinal mucosa has not been studied previously. The aim of the current study was to explore the alterations of intestinal mucosa morphology and barrier function, and to determine how rapidly the impairment of gut barrier function occurs and how long it persists following traumatic brain injury. METHODS: Male Wistar rats were randomly divided into six groups (6 rats each group) including controls without brain injury and traumatic brain injury groups at hours 3, 12, 24, and 72, and on day 7. The intestinal mucosa structure was detected by histopathological examination and electron microscopy. Gut barrier dysfunction was evaluated by detecting serum endotoxin and intestinal permeability. The level of serum endotoxin and intestinal permeability was measured by using chromogenic limulus amebocyte lysate and lactulose/mannitol (L/M) ratio, respectively. RESULTS: After traumatic brain injury, the histopathological alterations of gut mucosa occurred rapidly as early as 3 hours and progressed to a serious state, including shedding of epithelial cells, fracture of villi, focal ulcer, fusion of adjacent villi, dilation of central chyle duct, mucosal atrophy, and vascular dilation, congestion and edema in the villous interstitium and lamina propria. Apoptosis of epithelial cells, fracture and sparseness of microvilli, loss of tight junction between enterocytes, damage of mitochondria and endoplasm, were found by electron microscopy. The villous height, crypt depth and surface area in jejunum decreased progressively with the time of brain injury. As compared with that of control group (183.7 +/- 41.8 EU/L), serum endotoxin level was significantly increased at 3, 12, and 24 hours following TBI (434.8 +/- 54.9 EU/L, 324.2 +/- 61.7 EU/L and 303.3 +/- 60.2 EU/L, respectively), and peaked at 72 hours (560.5 +/- 76.2 EU/L), then declined on day 7 (306.7 +/- 62.4 EU/L, P<0.01). Two peaks of serum endotoxin level were found at hours 3 and 72 following TBI. L/M ratio was also significantly higher in TBI groups than that in control group (control, 0.0172 +/- 0.0009; 12 h, 0.0303 +/- 0.0013; 24 h, 0.0354 +/- 0.0025; 72 h, 0.0736 +/- 0.0105; 7 d, 0.0588 +/- 0.0083; P<0.01). CONCLUSION: Traumatic brain injury can induce significant damages of gut structure and impairment of barrier function which occur rapidly as early as 3 hours following brain injury and lasts for more than 7 days with marked mucosal atrophy.

Animals↗
PubMedDate not supplied

Massive pleural effusion and ascites resulting from esophagectomy with extensive lymphadenectomy for cancer of the abdominal esophagus.

Chylothorax is an uncommon but well recognized complication of esophagectomy. We present the case of a 57 year-old man with squamous cell carcinoma of the abdominal esophagus who underwent subtotal esophagectomy by right thoracotomy. Post-operatively, the volume of pleural effusion from the right chest was increased (1600-2000 ml/day). The effusion was straw colored, not changing to milky after meals. The characteristics and composition of the pleural fluid were similar to those of chyle. We therefore treated this patient using methods for treatment of chylothorax, conservatively, by administration of OK-432 and minocycline/hydrochloride into the pleural cavity from the chest tube with success. We discuss the pathophysiology of this unusual condition and its treatment.

Anti-Bacterial Agents↗
PubMed1999

[Chylothorax following myocardial revascularization with the internal mammary artery].

Chylothorax is a rare but serious complication of coronary artery bypass grafting. We describe a case of double myocardial revascularization with the internal mammary artery developing the complication ten weeks after cardiac surgery. The reasons for late symptomatology of lymphatic injury are analyzed. Conservative treatment with low-fat diet, total parenteral nutrition and pleural drainage was attempted unsuccessfully; chyle leakage of around 500 ml/day and onset of nutritional deficiency made it advisable to seal the thoracic duct surgically.

Aged↗
PubMed2001

[The estimation of the effectiveness of GRF glue in the respiratory].

We had reported on the basis of experimental findings that the efficacy of protecting the suture line in tracheoplasty by using a self-fascia lata and GRF glue. This time we investigated the effectiveness of GRF glue in the respiratory surgery on the basis of clinical findings. All ten cases in which GRF glue was used resulted in an excellent outcome, namely, GRF glue prevented from air leakage, bleeding and leakage of chyle. Moreover, it was not recognized that any grave side effects occurred in any cases after using GRF glue. We could conclude that GRF glue was a useful material for the respiratory surgery, especially for the case that had a dead space after lobectomy. However its price is not inexpensive, therefore, there seems need to restrict the use of GRF glue--for example--to cases of Giant bulla resection, residual of a large dead space as a postoperative possibility and chemotherapy performed before an operation, and so on.

Aged↗
PubMed1975

Chylothorax complicating radical neck dissection.

The third reported instance of chylothorax occurring after left radical neck dissection is presented and the literature reviewed. The pathogenesis appears to be lymphatic leakage in the neck with accumulation of chyle in the pleural space in spite of the absence of pneumothorax. The means for entry across an intact pleura is uncertain. The condition can be managed by conservative means consisting of adequate neck drainage and thoracentesis or chest tube drainage. A favorable outcome can be expected.

Carcinoma, Squamous Cell↗
PubMed2001

Chylous ascites in acute pancreatitis during pregnancy: case report.

Chylous ascites is a rare clinical manifestation characterized by ascitic chylomicrons resulting from mechanical obstruction of or leakage from the lymphatic channel. Chronic disorders, especially malignancies, account for most cases of chylous ascites. Acute chylous ascites is less common than the chronic form. We present a rare case of acute chylous ascites secondary to acute pancreatitis during the third trimester of pregnancy. This 24-year-old woman was referred to our emergency department because of severe epigastralgia for several days. Abdominal computed tomography revealed diffuse enlargement of the pancreas and peripancreatic exudation. Massive chylous ascites was found during emergent abdominal exploratory laparotomy. An emergent cesarean section was done because of fetal distress and there was no further accumulation of chyle. A pancreaticocutaneous fistula resulting from the cesarean section was treated successfully with a fistulectomy. In conclusion, chylous ascites is a rare complication of acute pancreatitis. Cesarean section may be helpful in terminating chylous accumulation in acute pancreatitis during the third trimester of pregnancy.

Acute Disease↗
PubMed2001

Chylothorax: a complication after internal thoracic artery harvesting.

Chylothorax is a rare but serious complication of cardiac surgery. A 64-year-old man with three-vessel disease underwent coronary artery bypass grafting. Ten days later he developed left pleural effusion. An intercostal drain was inserted and 1600 ml of pale pink, milky fluid were obtained. The results of biochemical analysis were consistent with chyle. The diagnosis of a left chylothorax was made. Conservative treatment consisting of total parenteral nutrition and pleural drainage was successfully employed. In the literature we found 17 cases in which the development of chylothorax after a coronary revascularization procedure is described.

Chylothorax↗
PubMed2001

[Bilateral chylothorax as initial manifestation of gastric cancer].

We describe a case in which bilateral chylothorax was the initial presenting manifestation of a gastric cancer (scirrhous type). A 58-year-old woman was admitted because of acute right subclavian vein thrombosis. Following admission, she complained of dyspnea on effort and on the 14th hospital day chest X-ray examination revealed bilateral pleural effusion. Biochemical tests of the pleural fluid detected chyle, and cytological examinations revealed mucinous adenocarcinoma bilaterally. An upper gastrointestinal examination revealed gastric cancer (scirrhous type). Carcinoma of the stomach has very rarely been described as the cause of chylothorax, but our findings indicate the need to rule out a gastric neoplasm in patients with chylothorax of no clear cause.

Adenocarcinoma, Scirrhous↗
PubMed2001

[A case of mediastinal thoracic duct cyst].

This is a rare case of thoracic duct cyst in 34-year-old woman. She complained of a left supraclavicular mass and admitted our hospital. A clinical examinations were all within normal limit. The chest X-ray and the magnetic resonance imaging examinations revealed a round tumor 65 x 40 mm in diameter with clear margin located at the left upper mediastinum. The slightly dilated thoracic duct was connected to the tumor. The left supraclavicular vein was compressed by the tumor. The cystectomy was performed under diagnosis of thoracic duct cyst by Trap door method on September, 17, 1999. Macroscopically, thin-capsulated elastic soft tumor contained chyle, and it was connected to the thoracic duct and the left jugular vein. The histological diagnosis was thoracic duct cyst. The postoperative course was uneventful, and the patient was discharged 9 days after operation. The patient remains disease-free at 8 months after the operation.

Adult↗
PubMed2001

[Chylothorax as the initial manifestation of malignant pleural mesothelioma--a case report].

A case of chylothorax associated with diffuse malignant pleural mesothelioma in a 53-year-old woman was reported. Chest radiography in a mass examination revealed right pleural effusion. A thoracentesis yielded fluid with characteristics consistent with chyle. In spite of our suggestion that thoracoscopy for further examination was necessary, the patient and her husband had refused the operation for months. Chest CT scanning revealed a nodule behind the xiphoid process. Lymphoscintigraphy suggested an obstruction of the right parasternal lymphatic vessel. Repeated thoracentesis did not yield a diagnosis. As bilateral pleural effusion and chylous ascites appeared, dyspnea worsened. About 2 years after the mass examination thoracoscopy was performed. On thoracoscopic exploration, a nodule was found in the anterior mediastinum and a biopsy was performed. Histological analysis revealed that the patient had the epithelial subtype of malignant pleural mesothelioma. Thoracoscopic pleural biopsy is a useful means of establishing the nature of a chylous effusion. In adult patients with chylothorax, thoracoscopic exploration should be performed as soon as possible to rule out malignancy.

Chylothorax↗
PubMedDate not supplied

[Nutritional support in chylothorax secondary to lymphoma].

Chylothorax is a well-known, albeit infrequent, complication in certain neoplasias including lymphomas. The continuing loss of chyle leads to a profound deterioration in patients' nutritional and immunological status, prevented only by appropriate early nutritional support. There is currently some dispute over its handling, particularly with regard to the most appropriate type of nutritional support and the suitability of conservative treatment versus surgery. The present paper describes the case of a 41-year-old patient diagnosed as having secondary chylothorax following B-cell lymphoma where mixed nutritional support (fat-free enteral nutrition by mouth and total parenteral nutrition) was given, followed by talc pleurodesis, with optimal results. There is a review of the literature and a discussion of the most controversial aspects of its management.

Adult↗
PubMed2002

Conservative treatment in an infant with superior vena cava syndrome after cardiac surgery.

Superior vena cava (SVC) syndrome rarely responds to conservative treatment. We report the case of a 2-month-old boy with SVC syndrome and bilateral chylothorax after surgical repair of the hemitruncus. Medical management with low-dose heparin, dipyridamole, and aspirin resulted in improvements of head swelling and chylothorax. The chyle had disappeared 46 days postoperatively. Compensatory growth of collateral vessels was also found. Although surgical repair is sometimes advocated in patients with SVC syndrome, medical treatment is an important alternative if the risk of surgery is too high.

Cardiac Surgical Procedures↗