Use of LeVeen pleuroperitoneal shunt for refractory high-volume chylothorax.
We present a case of intractable high-volume (> 2L/d) chylothorax after transhiatal esophagectomy treated successfully with the simultaneous insertion of both Denver (Denver Biomedical, Golden, CO) and LeVeen (Becton-Dickinson, Rutherford, NJ) pleuroperitoneal shunts. The patient initially had chemoradiotherapy for a T4N1 squamous cell carcinoma of the thoracic esophagus. Re-staging showed a dramatic shrinkage of tumor, and a transhiatal esophagectomy was performed. Sequential bilateral thoracotomies were performed on postoperative days 19 and 26 for attempted control of high-volume chylothorax, but these were unsuccessful. Subsequent pleuroperitoneal shunt insertion was used, which immediately controlled the effusion. A shunt study was performed shortly after hospital discharge, which showed an occluded Denver shunt and a patent LeVeen shunt. The patient succumbed to metastatic carcinoma 18 months after discharge, but no pleural effusion had recurred.
Gupta
Dipin
D
Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
Ross
Kerry
K
Piacentino
Valentino
V
Stepnowski
Dawn
D
McClurken
James B
JB
Furukawa
Satoshi
S
Dempsey
Daniel T
DT
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D002916:Chylothorax / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D000077143:Docetaxel; D004938:Esophageal Neoplasms / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D016629:Esophagectomy; D017809:Fatal Outcome; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010289:Parenteral Nutrition, Total; D010536:Peritoneovenous Shunt; D010996:Pleural Effusion / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D012121:Respiration, Artificial; D043823:Taxoids / Q000008:administration & dosage; D013907:Thoracostomy; D013908:Thoracotomy; D014014:Tissue Adhesives / Q000627:therapeutic use
D043823:Taxoids; D014014:Tissue Adhesives; D000077143:Docetaxel; D016190:Carboplatin; D002945:Cisplatin; D005472:Fluorouracil