Somatostatin analog treatment of a cervical thoracic duct fistula.
BACKGROUND
Reoperation for recurrent thyroid cancer poses an increased risk of complications, including thoracic duct fistula. Treatment of this complication is controversial. A survey of thoracic literature reports the use of somatostatin analog, whereas no cases have reported the use of this therapy in cases arising from neck dissection.


METHODS
We report a 16-year-old girl with recurrent papillary thyroid cancer who had a persistent lymphatic-cutaneous fistula develop after repeat modified left neck dissection. Despite conservative management, drainage persisted for 2 months. A regimen was begun that included TPN and injections of a somatostatin analog.


RESULTS
Treatment with a somatostatin analog resulted in an immediate attenuation of drainage and subsequent closure of the fistula after 16 days of treatment.


CONCLUSIONS
The use of somatostatin analog can increase the success of conservative management of thoracic duct fistulae.
Department of General Surgery, 785 Jelke Building, Rush-Presbyterian-St. Luke's Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612, USA.
Carl N
CN
Valentine
Roberto
R
Barresi
Richard A
RA
Prinz
D000293:Adolescent; D002291:Carcinoma, Papillary / Q000601:surgery; D005260:Female; D005402:Fistula / Q000150:complications / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D008196:Lymph / Q000187:drug effects* / Q000378:metabolism*; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D015282:Octreotide / Q000627:therapeutic use*; D011183:Postoperative Complications; D013897:Thoracic Duct / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000601:surgery
D005765:Gastrointestinal Agents; D015282:Octreotide