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Thoracoscopic ligation of the thoracic duct.

OBJECTIVE: When nonoperative treatment of chylothorax fails, thoracic duct ligation is usually performed through a thoracotomy. We describe two cases of persistent chylothorax, in a child and an adult, successfully treated with thoracoscopic ligation of the thoracic duct. METHODS: A 4-year-old girl developed a right chylothorax following a Fontan procedure. Aggressive nonoperative management failed to eliminate the persistent chyle loss. A 72-year-old insulin-dependent diabetic man was involved in a motor vehicle accident, in which he sustained multiple fractured ribs, a right hemopneumothorax, a right femoral shaft fracture, and a T-11 thoracic vertebral fracture. Subsequently, he developed a right chylothorax, which did not respond to nonoperative management. Both patients were successfully treated with thoracoscopic ligation of the thoracic duct. RESULTS: The child had significant decrease of chyle drainage following surgery. Increased drainage that appeared after the introduction of full feedings five days postoperatively was controlled with the somatostatin analog octreotide. The chest tube was removed two weeks after surgery. After two years' follow-up, she has had no recurrence of chylothorax. The adult had no chyle drainage following surgery. He was maintained on a medium-chain triglyceride diet postoperatively for two weeks. The chest tube was removed four days after surgery. After six months' follow-up, he has had no recurrence of chylothorax. CONCLUSIONS: Thoracoscopic ligation of the thoracic duct provides a safe and effective treatment of chylothorax and may avoid thoracotomy and its associated morbidity.

Aged↗
PubMed2005

[Thoracic trauma in elderly patients].

UNLABELLED: We investigated clinical character of thoracic trauma in the octogenarians in local city. Between Jan 2000 and Dec 2004, 369 patients with thoracic trauma were managed in our clinic and 3 local city hospitals in Oita. Ninety patients (23%) were aged 80 or above, 177 patients (46.7%), 64 or below, and 102 patients (26.9%), from 65 to 79. Blunt trauma occurred in the elderly. Penetrating trauma occurred in only 3 younger patients. In the octogenarians, causes of trauma were falls in 54 (60%) of the patients, traffic accidents in 15 (16.7%), and strained back in 14 (15.6%). Falls occurred on steps, most commonly, from flat surface as the elder fails to navigate environmental hazards or simply drops owing to a syncopal episode or loss of balance. Fractures of the thoracic vertebrae with or without rib fractures were observed in 29 (32.2%) of the octogenarians. Overall mortality was 2.3%. Three octogenarians (3.3%) died of pneumonia. Twenty-two (24.4%) of the octogenarians could discharge to their home, but the other 67 patients (74.4%) were referred to nursing home. CONCLUSION: Falls most commonly occur in the octogenarians. Occasionally, the patients require to discharge to nursing home, because of fracture of thoracic vertebrae or debilitated disorder.

Accidental Falls↗