Salvage and Reinfusion of Chyle in Closed Chest Injury

Abstract

The aim of this study was to describe a system of salvaging and reinfusing chyle which accumulated in the right pleural cavity of a patient after a thoracic duct lesion caused by a closed chest injury associated with amyelic fracture of the dorsal spine D10-D11. The chyle was collected in a reservoir (BT 844 Dideco), transferred by an electronic pump (BT 797 recovery Dideco) to a storage bag, microfiltered and then reinfused to the patient A solution was needed to prevent the patient with severe chylothorax, from having immunological and metabolic imbalance. The long period of conservative treatment with our system was imposed by the onset of acute post-traumatic myocardic infarction which delayed surgery. From experience gained, we can say that using total parenteral nutrition, chyle can not only be salvaged but also reinfused, respecting the strict rules of hygiene.

Disorders of the lymph circulation: their relevance to anaesthesia and intensive care

“…Chyle has been re-transfused into patients to prevent the loss of lymphocytes and proteins, but this procedure has inherent technical dif®culties. 44 Oral or enteral nutrition may increase lymph¯ow and therefore is not generally encouraged. Commercially available enteral feeds with a fat content less than 1 g litre ±1 , which are rich in medium chain triglycerides, may be suitable for some patients.…”

Management of thoracic duct injuries after oesophagectomy

“…An interesting new idea is to collect the chyle from the chest drain and reinfuse it back into the patient with the aim of reducing the immunological and metabolic consequences of prolonged chyle leakage 20 . This novel concept requires further evaluation.…”

“…Transhiatal 12 and thoracoscopic 17 resection appears to be associated with an increased risk of duct laceration. It is also well documented that the duct can be damaged as a result of cardiothoracic surgery 18 , blunt thoracic trauma 19,20 , penetrating thoracic injuries 21,22 , neck trauma 23,24 , neck surgery 25,26 , spinal fractures 27,28 and even radical nephrectomy 29 . Even with modern supportive and operative methods of treatment, the mortality rate in these patients is close to 30 per cent 30±32 .…”

Late Occurrence of Traumatic Chylothorax in a Multi-Trauma Patient With a Thoracic Spine Fracture-Dislocation

“…Chylothorax associated with thoracic vertebral injury was noted first by Krabbell in 1885 [15,16]. Until today there have been described several cases in bibliography [11,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Leturgie et al reported in 1979 a case of a patient with traumatic chylothorax in combination with a dorsal spine fracture [18].…”