Treatment of high-output thorasic chyle fistula with transabdominal embolization of cysterna chyli; A case report.

Oguzhan Ozsay2, Osman Nuri Dilek1, Volkan Cakir2, Selda Gucek Haciyanli2, Omur Balli2, Emine Ozlem Gur1, Mehmet Haciyanli1. 2Ataturk Research and Education Hospital, 1Katip Celebi University School of Medicine

Postoperative thorasic chylous fistula is an infrequent complication after esophageal surgery that represents a difficult management problem due to the serious mechanical, nutritional and immunological consequences of the constant loss of protein and lymphocytes. Management varies from conservative treatment with drainage, intravenous nutrition, medical management with different drugs applications, treatment and prevention of septic complications, lymphangiography for ductal embolization, to re-operation, either by thoracotomy or laparotomy to control the fistula.

A 65-year-old woman sequentially developed a high-output (2500 ml/day) thorasic chylous fistula and right-sided chylothorax, after a transhiatal total esophagectomy for adenocarcinoma of the distal esophagus. Multimodal procedures including low-triglyceride diet, sclerosing agens, repeated thoracentesis, and closed thoracostomy tube drainage had been applied for treatment within two months after surgery. Finally, embolization of the cysterna chyli with liquid embolic agents produced rapid clinical and radiographic improvement. The procedure of opacification, catheterization, and embolization of the cysterna chyli was successful.

Percutaneous transabdominal duct embolization is a safe, effective, and minimally invasive option for treating chylothorax. Here in, we discussed the case and treatment modalities in view of the literature.

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