title: Postoperative chylothorax successfully treated using conservative strategies.
abstract: The anatomy of the thoracic duct varies considerably, rendering it prone to disruption during thoracic surgery. Chylothorax complicates up to 0.5% of all intrathoracic procedures, its morbidity requiring the surgeon's vigilance throughout the entire course of the patient's illness. The natural history of chylothorax includes cardiopulmonary dysfunction, immunosuppression, nutritional and electrolyte derangements, and, ultimately, sepsis and death. General criteria for conservative management of thoracic duct injuries have been described in surgical literature, yet in selecting the best treatment for the patient, surgeons rely heavily on their own experience and the patient's unique presentation. A variety of conservative strategies may be implemented with success in approximately 50% of all cases. The duration of conservative treatment may vary, but the futility of conservative efforts should be recognized early and surgical intervention not delayed. We report a case of a 42-year-old man who presented at our institution with chylothorax after posterior mediastinal mass resection. The patient was treated successfully by withholding oral food and fluids, instituting total parenteral nutrition, and draining with a thoracostomy tube. He was discharged home with a complete resolution of chylothorax on hospital day 8. We describe the patient's illness course and discuss current strategies in the conservative management of thoracic duct injury after mediastinal resection.
authors.affiliation: Department of Surgery, Baylor University Medical Center, Dallas, Texas.
authors.forename: Victoria
authors.initials: V
authors.lastname: Stager
authors.forename: Lam
authors.initials: L
authors.lastname: Le
authors.forename: Richard E
authors.initials: RE
authors.lastname: Wood
references.citation: Eur Spine J. 2007 Dec;16 Suppl 3:332-7
references.pmid: 17273839
references.citation: J Thorac Cardiovasc Surg. 2000 Mar;119(3):453-7
references.pmid: 10694603
references.citation: Ann Surg. 1964 Jul;160:131-40
references.pmid: 14183080
references.citation: Calif Med. 1959 Aug;91(2):75-8
references.pmid: 13671361
references.citation: Br J Surg. 1997 Jan;84(1):15-20
references.pmid: 9043440
references.citation: Thorac Surg Clin. 2006 Feb;16(1):49-52
references.pmid: 16696282
references.citation: J Urol. 2002 Feb;167(2 Pt 1):449-57
references.pmid: 11792897
references.citation: Eur J Cardiothorac Surg. 2007 Aug;32(2):362-9
references.pmid: 17580118
references.citation: Respir Med. 2010 Jan;104(1):1-8
references.pmid: 19766473
references.citation: Br J Surg. 1997 Dec;84(12):1711-6
references.pmid: 9448622
references.citation: Br J Surg. 2001 Nov;88(11):1442-8
references.pmid: 11683738
references.citation: Ann Surg. 1973 Feb;177(2):245-9
references.pmid: 4698540
references.citation: Chest. 2008 Jun;133(6):1436-1441
references.pmid: 18339791