A rare case of thoracoscopic management of post operative chylous neck fistula

Abstract

Background: Thoracic duct injury is commonly iatrogenic. It can present as chylothorax, chylous neck fistula or rarely as chylopericardium. Injury to the main thoracic duct, rarely closes spontaneously while a chylothorax after lung resection rarely requires operative intervention as the leak is through the tributaries of the main duct. Chyle fistula can lead to high morbidity due to fluid loss causing nutritional deficiency and immunosuppression with mortality up-to 50%.

Methods: A 37 years old male was referred to our hospital with left supraclavicular malignant swelling which was a spindle cell tumor for which his local neck exploration and the excision of tumor was done. Patient had iatrogenic thoracic duct injury in the neck and developed a chylous neck fistula on post operative day 2, with output of 1200- 1400 ml chyle per day in drain. We did a video assisted thoracoscopic ligation of thoracic duct just at its entry point in right hemithorax between azygous vein and aorta.

Results: Patient had an uneventful post operative recovery with complete stoppage of chyle leak in the neck.

Conclusions: Conservative management of chyle leak is rarely successful and has high incidence of morbidity and mortality due to nutrition loss. VATS introduced in early 90’s has been applied in the management of chyle leak also. Injury to the main thoracic duct rarely closes spontaneously and surgical management in the form of thoracoscopic thoracic duct ligation is the treatment of choice.