Nutritional support in adults with chyle leaks

Sriram, Krishnan; Meguid, Robert A.; Meguid, Michael M.

doi:10.1016/j.nut.2015.08.002

Cited by 75 publications

(60 citation statements)

References 46 publications

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“…The initial management of a chyle leak usually includes drainage as well as TPN and bowel rest. Decreasing oral or enteral fat intake decreases the flow of chyle through the leak, possibly allowing spontaneous closure [92]. Long chain fatty acids should be avoided with diets supported by high percentages of medium-chain triglycerides since they are typically absorbed directly into intestinal cells, bypassing the thoracic duct [87].…”

Section: Chyle Leak/chylothoraxmentioning

confidence: 99%

Prevention and Management of Complications from Esophagectomy

Oxenberg¹

2018

Esophageal Cancer and Beyond

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While surgery plays a major role in the treatment and potential cure of esophageal cancer, esophagectomy continues to have a significant amount of morbidity compared to other surgical oncology procedures. Efforts to improve morbidity and mortality from esophagectomy include the Consensus Guidelines for Complications from Esophagectomies, Enhanced Recovery after Surgery protocols as well as others. Although we strive to improve morbidity and mortality after these surgeries, adverse events still occur. They affect not only patient quality of life and increase cost of care for esophageal cancer but also have a negative impact on overall cancer survival. This chapter reviews the prevention of adverse outcomes from esophagectomies as well as discusses the management of many complications that may occur more common to the operation.

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Section: Chyle Leak/chylothoraxmentioning

confidence: 99%

Prevention and Management of Complications from Esophagectomy

Oxenberg¹

2018

Esophageal Cancer and Beyond

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“…First, chyle contains fatty acids (Robinson, 1985). Secondly, patients with postoperative chyle leaks may be recommended to limit the oral intake of fatty foods as an initial management strategy to reduce the lymphatic flow (Sriram et al 2016). Therefore, fat absorbed in the intestine should be conveyed to the lymph, causing dilation of the thoracic duct after an intake of fat.…”

Section: Case Nomentioning

confidence: 99%

Magnetic resonance thoracic ductography assessment of serial changes in the thoracic duct after the intake of a fatty meal

et al. 2017

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The thoracic duct, a terminal lymph vessel, is thought to dilate after the intake of a fatty meal. However, this physiological change has not been well explored in vivo. Therefore, the present study aimed to assess serial changes in the thoracic duct after the intake of a fatty meal using magnetic resonance thoracic ductography (MRTD). Eight healthy volunteers were subjected to one MRTD scan before a fatty meal and eight serial MRTD scans every hour thereafter. The cross‐sectional areas of the thoracic duct were estimated using MRTD measurements of the diameters of the thoracic duct at the upper edge of the aortic arch, the tracheal bifurcation, the mid‐point between the tracheal bifurcation and the left part of the diaphragm and the left part of the diaphragm. The change‐rates in these areas were calculated before and after the fatty meal intake, and the maximal change‐rate and timing of its achievement were determined for each subject. The summed change‐rates in the four portions of the thoracic duct ranged from −40.1 to 81.3%, with maximal change‐rates for each subject ranging from 22.8 to 81.3% (mean, 50.4%). Although individual variations were observed, most subjects (88.9%) exhibited a maximal change‐rate at 4–6 h after meal intake, with subsequent decreases at 7–8 h. In conclusion, MRTD revealed a tendency toward thoracic duct enlargement at 4–6 h after the intake of a fatty meal, followed by contraction.

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“…The accumulation of chyle in the pleural space occurs secondary thoracic ductal disruption, transection, or increased lymphatic flow. 23 The diagnosis is obtained through routine laboratory evaluation of the pleural fluid (i.e. pH, lactate dehydrogenase, complete blood count, glucose, amylase) in addition to fluid triglyceride level.…”

Section: Cardiothoracic Surgery Commentary (Drs Bell and Meguid)mentioning

confidence: 99%