Learning objectives
1-Management of post-surgical chyle leak can be challenging and requires a multidisciplinary team input.
2-Failure of conservative measures in patients with high output leak and poor surgical candidates can be offered a minimally invasive procedure; thoracic duct embolisation.
3-Our case demonstrates that direct puncture of the leakage site under imaging guidance, followed by cannulating the transected duct, can be achieved with experienced interventionist.
Background
Chyle leak results from damage to the thoracic duct or right lymphatic duct, most commonly occurring during neck dissection; the proximity of the internal jugular vein and thin vessel wall, the thoracic duct is particularly susceptible to inadvertent injury during neck dissection. 14 It is a rare complication with potentially severe morbidity.
Chyle leak can lead to potential problems such as electrolytes disturbance, protein loss, malnutrition, dehydration, immunosuppression, chylothorax and localized complications, including wound dehiscence, skin flaps compromise, or even major vessel compromise.
Management will...
Imaging findings OR Procedure details
A 66-year-old male was admitted under the ENT team for elective total laryngectomy and bilateral neck dissection secondary to T4a laryngeal cancer.
He has a medical background of hypertension, T2DM, COPD, and schizophrenia. He underwent total laryngectomy and bilateral neck dissection with cricopharyngeal myotomy and insertion of voice prosthesis.
The operation was complicated by chyle leak during the dissection. The left thoracic duct was identified and ligated, and a neck drain left in-situ.
Outcome:
Ongoing leak was noted post-operatively, increasing gradually to exceed 1 L...
Conclusion
Chyle leak is the accumulation of chyle in the corresponding anatomical space, that can be caused by several aetiologies, among which malignancy and surgical trauma are the commonest. Chyle leak is associated with significant morbidity and mortality if left untreated.
Management therapy is dependant on symptoms, age, functional status and rate of chyle accumulation.1
The approach to treatment is usually a staged plan, moving form conservative, least invasive options to more invasive interventions. The general rule is, the larger the leak, the more likely the...
References
1. Huggins JT. Chylothorax and cholesterol pleural effusion. Semin Respir Crit Care Med 2010 Dec; 31(6):743-50.
2. Zabeck H, Muley, Dienemann H, Hoffmann H. Management of chylothorax in adults: when is surgery indicated. Thorac Cardiovasc Surg 2011 June; 59(4):243-6.
3. Miao L, Zhang Y, Hu H, et al. Incidence and management of chylothorax after esophagectomy. Thorac Cancer 2015 May; 6(3):354-8.
4. Ferguson MK, Little AG, Skinner DB. Current concepts in the management of postoperative chyloihorax. Ann Thorac Surg 1985 Dec; 40(6):542-5.
5. Toliyat M, Singh...