Bilateral chylothorax following neck dissection

Jabbar, Alaa S. Abdul; Al-Abdulkareem, Abdulmajeed

doi:10.1002/hed.2880170115

Cited by 22 publications

(19 citation statements)

References 12 publications

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“…This process is attributed to damage of the thoracic duct or a notable chylous leakage in the cervical region. According to the other hypothesis, the increased intraluminal pressure in the thoracic duct after ligation of the duct coupled with the negative intrathoracic pressure during inspiration leads to an atraumatic leak of chyle into the mediastinum, which finally extravasates through one or both mediastinal pleurae into the pleural cavity, producing chylothorax [12]. All of our three patients suffered injury to the thoracic ducts and underwent ligation or transfixion of the thoracic ducts during neck dissection.…”

Section: Discussionmentioning

confidence: 97%

Chylothorax after neck dissection for thyroid carcinomas: report of three cases

Tian

Wang

et al. 2011

Surg Today

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Chylothorax is a rare complication of neck dissection. We report three cases of chylothorax after neck dissections for thyroid carcinoma and attribute this relatively high incidence to the assumption that most patients are asymptomatic. Thus, conventional chest X-ray or ultrasonography in the early postoperative period may be warranted to exclude asymptomatic chylothorax, especially if the thoracic duct is injured and ligated during the operation. We suggest that for chylothorax induced by ligation of the thoracic duct, which may be transient and resolve quickly, short-term thoracic drainage is enough.

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Section: Discussionmentioning

confidence: 97%

Chylothorax after neck dissection for thyroid carcinomas: report of three cases

Tian

Wang

et al. 2011

Surg Today

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“…Chylothorax is a life-threatening situation that may require repeated incision drainages of the thorax, low-fat diet, parenteral nutrition and sometimes suture ligation if not responding to the previously mentioned measures of treatment [427], [432], [467], [468]. Since dyspnea may also result from a lesion of the phrenic nerve [469] diagnosis of a chylothorax is based on an X-ray of the thorax [470]. A single-sided lesion of the phrenic nerve usually is not clinically apparent and only sometimes complicated by pulmonary atelectasis and subsequent infection [471].…”

Section: Discussionmentioning

confidence: 99%

Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology

Windfuhr

2013

GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery; 12:Doc08; ISSN 1865-1011

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“…Ein Chylothorax kann wegen der kardiorespiratorischen und metabolischen Eff ekte wiederholte Thorakozentesen, fettarme Diät, parenterale Ernährung und bei Persistenz seine Ligatur erfordern [ 417 , 422 , 456 , 457 ] . Da eine Dyspnoe sowohl durch eine Phrenicusläsion [ 458 ] wie auch einen Chylothorax verursacht werden kann, ist immer eine Röntgen-Thoraxuntersuchung indiziert [ 459 ] . Eine einseitige Phrenikusschä-digung ist in der Regel symptomarm, kann aber über Atelektasenbildung die Voraussetzungen für Entzündung schaff en [ 460 ] .…”

Section: Postoperativunclassified

Fehler und Gefahren: Tonsillektomie und andere Standard-Eingriffe

Windfuhr

2013

Laryngo-Rhino-Otol

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Septoplasty, tonsillectomy (with and without adenoidectomy) and cervical lymph node excision are amongst the most common 50 inpatient operations in Germany. Intracapsular tonsillectomies (i.e., tonsillotomies) are increasingly performed. The aim of this study was to evaluate alleged medical malpractice, technical traps and pitfalls associated with tonsillectomy (TE), adenoidectomy (AE), tonsillotomy (TT), septoplasty (SP) and cervical lymph node excision (LN).A questionnaire was sent to the Regional Medical Conciliation Boards, Medical Services of the Health Insurance Companies (MDK) and Regional Institutes of Forensic Medicine in Germany to collect anonymized cases of complications or medico legal implications following TE, TT, AE, LN and SP. The results were discussed in the light of the contemporary medical literature and published verdicts in Germany.The response rate of our survey was 55.9%. The Institutes of Forensic Medicine contributed 9 cases, 49 cases were submitted by the Regional Conciliation Boards and none by MDK. All forensic cases were associated with exsanguinations following tonsillectomy including 2 children (5 and 8 years of age) and 7 adults (aged 20-69 years). The fatal post-tonsillectomy hemorrhage (PTH) had occurred 8.7 days on average; 4 patients experienced the bleeding episode at home (day 5, 8, 9 and 17, respectively). Repeated episodes of bleeding requiring surgical intervention had occurred in 6 patients. 3 Conciliation Boards submitted expert opinions concerning cases TT (1), AE (4), LN (3), SP (16) and TE (25). Cases with lethal outcome were not registered. Only 3 of the 49 cases were assessed as surgical malpractice (6.1%) including lesion of the spinal accessory nerve, wrong indication for TE and dental lesion after insertion of the mouth gag. The review of the medico legal literature yielded 71 published verdicts after AE and TE (29), LN (28) and SP (14) of which 37 resulted in compensation of malpractice after LN (16; 57%), TE (11; 41%), SP (8; 57%) and AE (2; 100%). There were 16 cases of PTH amongst 27 trials after TE resulting either in death (5) or apallic syndrome (5). Bleeding complications had occurred on the day of surgery in only 2 patients. 16 trials were based on malpractice claims following SP encompassing lack of informed consent (6), anosmia (4), septal perforation (2), frontobasal injury (2) and dry nose (2). Trials based on LN were associated exclusively with a lesion of the spinal accessory nerve (28), including lack of informed consent in 19 cases. 49 cases (69%) were decided for the defendant, 22 (31%) were decided for the plaintiff with monetary compensation in 7 of 29 AE/TE-trials, 9 of 28 LN-trials and 6 of 14 SP-trials. Lack of informed consent was not registered for AE/TE but LN (11) and SP (2).Complicated cases following TE, TT, ATE, SP and LN are not systematically collected in Germany. It can be assumed, that not every complicated case is published in the medical literature or law journals and therefore not obtainable for scientific research. Alleged ...

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Bilateral chylothorax following neck dissection

Abstract: After neck dissection, the clinician should suspect chylothorax if the patient had respiratory embarrassment and an abnormal chest x-ray postoperatively.

Cited by 22 publications

References 12 publications

Chylothorax after neck dissection for thyroid carcinomas: report of three cases

Chylothorax after neck dissection for thyroid carcinomas: report of three cases

Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology

Fehler und Gefahren: Tonsillektomie und andere Standard-Eingriffe

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