Atypical presentation and transabdominal treatment of chylothorax complicating esophagectomy for cancer

Rottoli, Matteo; Russo, Iris S; Bernardi, Daniele; Bonavina, Luigi

doi:10.1186/1749-8090-7-9

Cited by 10 publications

(8 citation statements)

References 7 publications

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“…As reported by Rottoli et al . [2], chylous fluid would usually drain into the right thoracic cavity, even if a chylocele developed in the posterior mediastinum. Interestingly, vertebral column prevented chylous fluid from draining into the right thoracic cavity in this patient; therefore, no chyle drainage from the right chest tube was seen throughout the clinical course.…”

Section: Discussionmentioning

confidence: 99%

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Cardiac tamponade communicating with a posterior mediastinal chylocele after esophagectomy

Kosugi

Hashimoto

Sato

et al. 2017

Journal of Surgical Case Reports

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A 75-year-old male received neoadjuvant chemotherapy for locally advanced squamous cell carcinoma of the mid-thoracic esophagus, followed by right transthoracic esophagectomy with extended mediastinal lymphadenectomy. Cardiac tamponade developed on postoperative Days 1 and 13, for which emergency ultrasound-guided drainage was required. Pericardial drainage fluid became chylous after administration of polymeric formula. A computed tomography scan demonstrated the presence of a retrocardiac fluid collection, encompassed by the left pulmonary vein and left atrium, descending aorta and vertebral column. Based on these findings, the diagnosis of chylopericardial tamponade communicating with a posterior mediastinal chylocele was made. The ligation of the thoracic duct was successfully performed via the left-sided thoracoscopic approach on postoperative Day 20 and the clinical course after the second operation was uneventful. The possible mechanisms of this exceptionally rare complication after esophagectomy were discussed.

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Section: Discussionmentioning

confidence: 99%

“…One is due to extrinsic compression of the heart, caused by the herniated colon [1], mediastinal chylocele [2] and dilated gastric tube [3]. This condition is mimicking typical cardiac tamponade and referred to as extrapericardial tamponade.…”

Section: Introductionmentioning

confidence: 99%

Cardiac tamponade communicating with a posterior mediastinal chylocele after esophagectomy

Kosugi

Hashimoto

Sato

et al. 2017

Journal of Surgical Case Reports

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“…Conservative treatment provides Chyle is a milky bodily fluid consisting of long-chain . Rottoli et al 21 and Barbetakis et al 22 …”

Section: Discussionmentioning

confidence: 99%

Lymphangiography Was Useful in Postoperative Intractable Chylothorax after Surgery for Esophageal Cancer: A Case Report

et al. 2017

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Postoperative chylothorax after surgery for esophageal cancer is a rare but serious complication. Treatment initially consists of conservative therapy and, if it fails to provide improvement, it is important to perform surgical treatment without delay. We report on a recent case of intractable chylothorax. This report describes a 72-year-old man with Stage III esophageal squamous cell carcinoma. Subtotal esophagectomy, through a right thoracoabdominal approach with two-field lymphadenectomy, and cervical esophagogastric anastomosis via the retrosternal route, were performed. On the 12th postoperative day, a diagnosis of chylothorax was made. Conservative treatment was initiated, but it proved to be ineffective. Therefore, ligation of the thoracic duct via a thoracotomy was performed, but this was not effective, either. Lymphangiography undertaken to identify the site of the leak in the thoracic duct enabled a diagnosis of an extremely rare double thoracic duct and identification of the site of the leak in the thoracic duct, thereby allowing curative direct ligation of the site. This case underscores the remarkable usefulness of lymphangiography in dealing with intractable postoperative chylothorax. (J Nippon Med Sch 2017; 84: 268 273)

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“…Delayed recognition of chyle loss may occur after removal of the chest drain and return to oral feeding; in such circumstances, the patient can be readmitted with dyspnea and pleural effusion showing the typical milky appearance. Atypical presentation with severe hemodynamic instability from mediastinal chylocele is unusual …”

Section: How Should We Manage Chylous Leak After Esophagectomy?mentioning

confidence: 99%

“…In some circumstances, such as previously failed transthoracic procedures, transabdominal ligation of the cisterna chyli via laparotomy or laparoscopy represents a viable alternative to the thoracic approach . After gentle left displacement of the gastric tube at the level of the diaphragmatic hiatus, multiple suture ligations of the cisterna chyli and the thoracic duct at its origin are performed transhiatally on the right side of the aorta.…”

Section: How Should We Manage Chylous Leak After Esophagectomy?mentioning

confidence: 99%

Surgical treatments for esophageal cancers

Allum

Bonavina

Cassivi

et al. 2014

Annals of the New York Academy of Sciences

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The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on the role of the nurse in preparation of esophageal resection (ER); the management of patients who develop high-grade dysplasia after having undergone Nissen fundoplication; the trajectory of care for the patient with esophageal cancer; the influence of the site of tumor in the choice of treatment; the best location for esophagogastrostomy; management of chylous leak after esophagectomy; the optimal approach to manage thoracic esophageal leak after esophagectomy; the choice for operational approach in surgery of cardioesophageal crossing; the advantages of robot esophagectomy; the place of open esophagectomy; the advantages of esophagectomy compared to definitive chemoradiotherapy; the pathologist report in the resected specimen; the best way to manage patients with unsuspected positive microscopic margin after ER; enhanced recovery after surgery for ER: expedited care protocols; and long-term quality of life in patients following esophagectomy.

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Atypical presentation and transabdominal treatment of chylothorax complicating esophagectomy for cancer

Cited by 10 publications

References 7 publications

Cardiac tamponade communicating with a posterior mediastinal chylocele after esophagectomy

Cardiac tamponade communicating with a posterior mediastinal chylocele after esophagectomy

Lymphangiography Was Useful in Postoperative Intractable Chylothorax after Surgery for Esophageal Cancer: A Case Report

Surgical treatments for esophageal cancers

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