Chylothorax after mediastinal ganglioneuroma resection treated with fibrin sealant patch: a case report

Abstract

Chylothorax is a severe condition resulting from the accumulation of chyle into the pleural space.We report the treatment of postoperative chylothorax after resection of mediastinal ganglioneuroma in a 17-year-old boy. Since conservative measures were not effective, we performed direct ligation of lymphatic vessels and pleurodesis. At subsequent surgical re-exploration for persisting chylothorax, accurate inspection of pleural cavity revealed residual chyle leakage. Fibrin sealant patches (TachoSil ® ) were placed over the source of leak with complete resolution of chylous effusion. To our knowledge, this is the first report of postoperative chylothorax successfully treated by the use of a fibrin sealant patch.

Chylothorax after thoracoscopic extended thymectomy: a case report and literatures review

“…Chylothorax remains an uncommon but challenging clinical problem and the management varies depending on the etiology, the duration or the degree of chylothorax (3,4). In this case, conservative treatment including total parenteral nutrition, fasting and low fat diet and chest tube drainage was performed and chylothorax was controlled successfully, although the duration of chylothorax was relatively long (26 days).…”

Chylothorax After Schwannoma Resection

“…In a case of chylothorax after surgical resection of a paravertebral ganglioneuroma in a 17year-old boy, chest tubes, intravenous octreotide, TPN, direct thoracic duct ligation, and pleurodesis all failed to reduce drainage, which reached 0.9-1.2 L/day [8]. Ultimately, only sealing the suspected sources of leakage over the site of the surgical sutures in the left paravertebral sulcus using fibrin sealant patches led to the resolution of the chylothorax [8]. Another case of chylothorax after thoracic schwannoma resection in a 40-year-old man saw drainage of 1.5 L/day but saw successful resolution on fasting, TPN, and subcutaneously-administered somatostatin after 40 postoperative days [9].…”

“…However, given the rarity of chylothorax incidence, management of this urgent complication is challenged by a lack of high-quality randomized controlled trials (RCTs) that can generate a universal management algorithm [7]. In a case of chylothorax after surgical resection of a paravertebral ganglioneuroma in a 17year-old boy, chest tubes, intravenous octreotide, TPN, direct thoracic duct ligation, and pleurodesis all failed to reduce drainage, which reached 0.9-1.2 L/day [8]. Ultimately, only sealing the suspected sources of leakage over the site of the surgical sutures in the left paravertebral sulcus using fibrin sealant patches led to the resolution of the chylothorax [8].…”

Use of Tachosil® as an adjuvant therapeutic option in neurotrophic keratopathy in order to prevent perforation

“…Tachosil ® is a fibrin sealant patch resulting from equine collagen coated with human fibrinogen and thrombin,[1] which forms a fibrin clot when exposed to body fluids allowing the collagen to adhere to the tissue surface. [2] It is mainly used by different surgical specialties in order to achieve hemostasis, although other uses such as preventing chylothorax[3] or during prosthesis implantation in patients with Peyronie's disease[4] have been described.…”