Lesion of thoracic duct: Clinical case report

Sara Dessalvi, Francesco Boccardo, Corrado Cesare Campisi, Lidia Molinari, Stefano Spinaci, Chiara Cornacchia, Giulio Bovio, Carlo Ferro, Mauro Ferrari, Corradino Campisi

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Chylous leakage is a relevant clinical problem after major abdominal or thoracic surgery. Literature report an incidence of chylous leakage of about 7%. An accurate diagnostic study is indispensable to plan the correct therapeutic approach. Surgical and interventional approaches are reserved for cases refractory to conservative treatment. Clinical presentation: In July 2014, a 76-year-old male was diagnosed with locally advanced adenocarcinoma of the gastroesophageal junction. After chemotherapy, in November 2014 an Ivor Lewis esophagectomy was performed. After 1 month the patient developed a massive chylous ascites. Initially he underwent conservative treatments. An accurate diagnostic study with lymphangio-CT (LAG-CT) showed the chylous leakage at the lower third of the thoracic duct. Different attempts of embolization of the chylous leakage were carried out but the ascites and the metabolic imbalance persisted. On February 2015, a laparotomic approach was performed and the chylous leakage was confirmed with a fatty meal and treated with non-absorbable suture material and platelet gel. Results: The patient was followed up clinically and instrumentally (with echo-scan and TC) for 6 months postoperatively. Lab tests demonstrated a progressive improvement of the metabolic and immunologic conditions. No recurrence of chylous ascites appeared. Conclusions: According to Authors' experience, LAG-CT represents the gold-standard in the diagnostic work-up in patients affected from thoracic duct lesions. Angio-radiologic approach is a valid solution but not always successful, especially for extensive damages of the thoracic duct. The surgical approach remains the last therapeutic solution for chyloperitoneum refractory to non-operative treatment and more recently it is efficaciously associated with the use of platelet gel or fibrin glue.

Original languageEnglish
Pages (from-to)29-31
Number of pages3
JournalEuropean Journal of Lymphology and Related Problems
Volume29
Issue number77
Publication statusPublished - Jan 1 2017

Keywords

  • Chyloperitoneum
  • Chylous ascites
  • Chylous leakage
  • Therapy
  • Thoracic duct lesion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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