Nutrition therapy plays a major role in the conservative treatment of chyle leaks. Evolution of chylous fistula management after neck. The main purpose of this study was to assess the feasibility and relevant applying techniques of total thyroidectomy for thyroid carcinoma with a modified miccolis approach. High output chylous fistulae are difficult to manage and have local, metabolic, and immunologic complications with a mortality rate varying from 12.
Chylous fistula following radical neck dissection is a disturbing and potentially serious complication. A chylous fistula after a modified radical mastectomy is a rare occurrence. Chylous fistula following surgical lumbar sympathectomy by g. The lipids in the chyle are colloidally suspended in chylomicrons clinical significance. Case report a 56yearold patient was admitted to our hospital with a malignant tumor of the left floor of the mouth t3nomx. Conclusions and relevance in these patients, octreotide was safe and effective in resolving neck chylous fistulas. Durrani department of plastic surgery, addenbrookes hospital, hills road, cambridge cb23 3le, uk. In these cases, if a womans labor becomes obstructed, she will endure days of painful, prolonged labor. The two great causes of obstruct inside the mothers uterus. The removal of the ester group of 2 monoacylglycerol requires isomerization to a primary ester linkage. Chest radiographs in patients with chylous fistula can demonstrate a softdensity opacity at the root of the neck. If there is a chyle leak, the chyle can build up and cause swelling and other. An experience with chyle fistula was reported from the netherlands cancer institute.
Fistulas are generally the result of a disease condition, but. Chylous fistula, one case of which was associated with chylothorax, appeared in three patients. Most chylous fistulae after radical neck dissection are successfully treated conservatively. A 52yearold patient with a chylous fistula after modified radical neck dissection was successfully treated by a lymphovenous anastomosis of the td and external jugular vein with additional coverage by sternocleidomastoid muscle flap. Chylous ascites consists of the accumulation of chyle in the abdominal cavity. Chyle leak formation is an uncommon but serious sequela of head and neck surgery when the thoracic duct is inadvertently injured, particularly with the resection of malignancy low in the neck. Minimally invasive management of chylous fistula after esophagectomy chyle leak is an unwelcome complication of esophagectomy that is associated with a high mortality. Eightysix patients with thyroid carcinoma consecutively received radical operation from october 2007 to june 2012. In addition to imaging the lymphatics and detecting various types of lymphatic leakage, lymphangiography is a therapeutic option for patients with chylothorax, chylous ascites, and lymphatic fistula. Chyle fistula is defined as a leakage of lymphatic fluid from the lymphatic vessels, typically accumulating in the thoracic or abdominal cavities, but occasionally manifesting as an external fistula. Treatment of chyle fistulas is determined by the following see treatment etiology of the fistula. Plastic surgical treatment of a chronic thoracic duct. Selfresolving nausea was encountered in 1 patient from octreotide use, and 1 patient developed a salivary fistula as a result of the chylous fistula. Management of chylous fistula as a complication of neck.
The diagnosis of this condition may be difficult or delayed and requires a high index of suspicion. First described in the 17th century as complications of trauma, chyle fistulas most commonly occur secondary to lymphatic. Direct percutaneous lymphography and interventional. The patient showed a complete resolution of chylous leak with an uneventful postoperative course. Introduction chylous ascites is an uncommon finding 1 which is due to the presence of thoracic or intestinal lymph in the abdominal cavity. Full text full text is available as a scanned copy of the original print version. Severe cervical chyle fistula after radical neck dissection. Component concentration calories 200 kcall lipids 530 gl protein 2030 gl lymphocytes 4006800mm 28 sodium 104108 mmoll potassium 3. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather. Av fistula for dialysis preparing a vascular access is an important step to take before you start regular hemodialysis sessions. It is important in order to avoid any risk of chylous fistula to accurately seal and divide any vessel of the cyst.
Management of chyle leaks following pancreatic resection. Evidence of chyle extravasation occurs within hours after neck dissection, and is not difficult to diagnose. He is also a member of the european society of lymphology and the international society of lymphology. Chylous mesenteric cysts have an estimated incidence of 7. Use of octreotide for chyle fistula following neck dissection. Get a printable copy pdf file of the complete article 373k, or click on a page image below to browse page by page. Introduction damaging or cutting a thoracic duct while operating low on the left side of the neck does not occur infrequently, even in experienced hands.
The thoracic duct is the primary structure that returns lymph and chyle from the entire left and right lower half of the body. Clinically, chylous fistulas may be difficult to manage because of significant electrolyte, fluid, and protein imbalance. Score curriculum outline 20172018 patient care portal. Although rar e, when such leaks occur, they are often difficult to manage and correct. Clinical experience with modified miccolis endoscopic. Chylous ascites after an hgraft interposition mesocaval.
Obstetric fistula is a serious problem in the worlds poorest countries, where most mothers give bi any medical help. We conducted a retrospective study of 304 patients, 295 97. Chyle fistula is a rare but potentially devastating and morbid condition. Chylous ascites may result from diverse pathologies. A fistula is an abnormal, tubelike connection that forms between two organs or vessels that are lined with epithelial cells. Use of octreotide for the management of chyle fistula following. Background due to the small size of lymph vessels the detection of a lymph fistula is challenging. What should be avoided, however, is the failure to.
Ca develops secondary to traumatic injury or obstruction of the lymphatics, causing the leakage of chyle through the walls of dilated lymphatic vessels or a lymphoperitoneal fistula. Journal articles obstetric fistula research project. Percutaneous thoracic duct embolization, transabdominal catheterization of the cisterna chyli or thoracic duct, and subsequent embolization of the thoracic duct is an alternative to surgical ligation of the thoracic duct. Functional repair of the lymphatic duct injury should be the preferred solution, rather than an approach. Chylous fistula following radical neck dissection is a disturbing and potentially. Johnson, 19 july 2007, pages s122s129 abstract fulltext pdf 173 kb fistula fortnight. In fact, transecting the duct when carrying out radical surgery low down in the neck or the mediastinum may often be necessary. Digestion and absorption process biology discussion. Obstructed labour is one of the leading causes of maternal mortality in developing countries and. Get a printable copy pdf file of the complete article 998k, or click on a page image below to browse page by page. Thoracic duct fistula is a rare but potentially serious complication of head and neck surgery. Links to pubmed are also available for selected references. Use of octreotide for the management of chyle fistula following neck dissection article pdf available in jama otolaryngology head and neck surgery 1418 july 2015 with 407 reads.
He attended surgery of lymphatic pathologies and microsurgery and received two masters in reconstructive. First described in the 17th century as complications of trauma, chyle fistulas most commonly occur secondary to lymphatic disease or malignancy or following abdominal, neck, or thoracic operations. The pathophysiology of this unusual accumulation of chyle in three separateanatomic compartments is. Such fistulae may be difficult to treat, and several techniques, both operative and nonoperative, have been advocated. Chylous leakage from the lymphatic system is a complex problem usually resulting from injury or abnormality of the thoracic duct. Chylous fistula after lateral neck dissection for thyroid cancer is a rare but serious complication. A cavity above the gland was constructed by a modified suspension method using the. Chyle extravasation can result in delayed wound healing, dehydration. We report the first case of chylous ascites following radical nephrectomy for a renal cell carcinoma involving the right half of a crossed fused renal ectopia. Chylous fistula is a serious complication of neck surgery. Meticulous surgical technique in the areas of the thoracic duct on the left and the lymphatic ducts on the right will usually prevent the occurrence of a chylous leak.
A gastrointestinal fistula is an abnormal opening that causes gastric fluids to be discharged through the lining of the stomach or intestines. Chylous fistula following surgical lumbar sympathectomy. The occurrence of a massive lymphatic flow lead us to continue in research of new conservative treatment. Ascites results either due to blockage of the lymphatics or leak secondary to inadvertent trauma during surgery. Lymphovenous anastomosis for the treatment of thoracic. Management of chyle fistulization in association with neck. Pdf evolution of chylous fistula management after neck dissection. Prompt identification and treatment of a chyle leak are essential for optimal surgical outcome.
The leak may happen after an injury or surgery to the. Chylothorax is an uncommon complication of chylous fistula and may be seen on chest radiographs as a pleural effusion. Chylous fistula is a wellrecognised but rare complication of headandneck. Scribd is the worlds largest social reading and publishing site. An analysis of national and international guidelines. Meticulous surgical technique in the areas of the thoracic duct on the left and the lymphatic ducts. Innovative partnership brings mass treatment and public awareness towards ending obstetric fistula k. Chylous fistula is an infrequent complication of head and neck surgery, with an incidence reported in % of patients undergoing major neck. Chyle from the greek word chylos, juice is a milky bodily fluid consisting of lymph and emulsified fats, or free fatty acids ffas. The fistula occurred in a 51yearold female following treatment of a solitary. A vascular access should be prepared weeks or months before you start dialysis. Management of chyle leak after head and neck surgery. It is a rare but potentially devastating and morbid condition. Lymphangiography to treat postoperative lymphatic leakage.
As a result, monoacylglycerols are the major end products of fat digestion and less than onefourth of the ingested fat is completely broken down to glycerol and fatty acids. One chylous fistula arose on the right side and 10 on the left. The aim of this study was to analyse the incidence, treatment and evolution of chylous fistula in neck dissection. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Chylous fistula of the neck free download as powerpoint presentation. Get a printable copy pdf file of the complete article 415k, or click on a page image below to browse page by page.
Repair of chylous fistula in the neck by local muscular flaps. Chylous fistula is a rare complication of esophagectomy that is reported to occur in 24% of cases. Treatment of a chylous fistula in the neck with thoracic duct. A case of successful surgical treatment of a chronic thoracic duct fistula is presented. Attention is directed to the variations in the anatomical distribution of the cervical lymphatics. When fat is reduced in the diet, the body makes less chyle. A vascular access is the site on your body where blood is removed and returned during dialysis. Chylous ascites as a complication of infrahepatic inferior vena cava tumor resection. A 65yearold man sequentially developed a chylous neck fistula, leftsided chylothorax,and chylous ascites after a transhiatal total esophagectomy for adenocarcinoma of the distalesophagus. Some fistulas can be detected by lymphography and lymph scintigraphy. Management of chylous fistulas myers en, dinerman ws. Chyle fistula is defined as a leakage of lymphatic fluid from the lymphatic vessels, typically accumulating in the thoracic or abdominal cavities but occasionally manifesting as an external fistula. Chylous fistulas are known to lead to prolonged hospitalization. It is formed in the small intestine during digestion of fatty foods, and taken up by lymph vessels specifically known as lacteals.
173 1280 959 453 875 1415 186 52 1128 81 735 1073 1452 962 1584 1249 1056 454 595 249 192 1365 1288 570 942 950 93 54 962 1380 1376 1073 803 906 1233 585 852 75 1450 415 107