Diagnosis and treatment of postoperative chyle leakage via percutaneous transabdominal catheterization of the cisterna chyli: a preliminary study.
OBJECTIVE
To assess the feasibility of percutaneous transabdominal puncture and catheterization of the cisterna chyli or lymphatic ducts (PTCLD) in patients with postoperative chyloperitoneum and chylothorax, and to identify and possibly embolize the chylous fistula.


METHODS
Five patients had postoperative uncontrolled chyle fistulas. Two patients with chylothorax had thoracic duct (TD) ligation after esophagectomy and neck surgery. The other three patients had chylous ascites after surgery of the pancreas, the aorta, and the esophagus, respectively. After lymphographic opacification, the cisterna chyli (CC) or retroperitoneal lymph ducts were punctured transabdominally with a 21-gauge needle and catheterized with a 3-F catheter to reach the TD if possible. Microcoils were used to embolize a TD laceration.


RESULTS
Lymph ducts as small as 2-3 mm were catheterized successfully in three patients. The TD was catheterized in two patients; one TD fistula was embolized with cure of chylothorax. In one patient with a surgically tied TD, duct occlusion was confirmed despite continued pleural effusion. Three fistulas, not seen with lymphography, were identified in two of three chylous ascites and one chylothorax. There was no morbidity. As a result of this procedure, four of five patients did not require repeated operation.


CONCLUSIONS
PTCLD in the study of chyle fistulas was feasible and safe in the management of five patients and clinically useful in four patients; transabdominal catheter lymphography with aqueous contrast medium is more sensitive than pedal lymphography. Further evaluation is necessary.
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
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Cope
D000368:Aged; D002404:Catheterization / Q000379:methods*; D002916:Chylothorax / Q000000981:diagnostic imaging* / Q000628:therapy*; D002915:Chylous Ascites / Q000000981:diagnostic imaging* / Q000628:therapy*; D004621:Embolization, Therapeutic; D005240:Feasibility Studies; D005260:Female; D005402:Fistula / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D008208:Lymphatic System; D008220:Lymphography / Q000379:methods; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D011446:Prospective Studies; D011677:Punctures; D013897:Thoracic Duct