title: Life threatening presentation of thoracic duct injury post thyroid surgery; a case report.
abstract: BACKGROUND
  Injury to thoracic duct is a rare potential complication of time-honored conventional thyroidectomy. Nevertheless, it can be a cause of significant morbidity, and sometimes life-threatening.
  
  
  METHODS
  A 78-year-old female patient with a previous surgical history of thyroid lobectomy for nodular disease presented with primary hyperparathyroidism, and a nodule in the remaining thyroid lobe. The patient underwent completion thyroidectomy and parathyroidectomy. Less than 24h post operatively, the patient developed progressive shortness of breath and neck swelling requiring immediate intubation and re-exploration. A large amount of chyle was drained and an injured thoracic duct was identified and ligated.
  
  
  CONCLUSIONS
  In experienced hands thyroid surgery is safe. Nevertheless, factors such as the type of pathology and its extent, the level of surgery, and re-operative surgery increase the risk of postoperative complications. Immediate surgical exploration is necessary when patients present with neck swelling and respiratory distress. In our case, a high output chyle leak in a confined space was life threatening.
  
  
  CONCLUSIONS
  Timely re-exploration following thyroid surgery and thorough knowledge of the anatomy of neck structures is crucial in sparing patients potential morbidity and/or mortality.
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, PO Box 11-0236, Cairo Street, Riad El Solh, Beirut 1107 2020, Lebanon. Electronic address: Halawani.md@gmail.com.
authors.forename: Hamzeh M
authors.initials: HM
authors.lastname: Halawani
authors.affiliation: Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan. Electronic address: Sohail.bakkar@gmail.com.
authors.forename: Sohail
authors.initials: S
authors.lastname: Bakkar
authors.affiliation: American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: sfj01@mail.aub.edu.
authors.forename: Sarah F
authors.initials: SF
authors.lastname: Jamali
authors.affiliation: Department of Immunology and Microbiology, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: fmk14@mail.aub.edu.
authors.forename: Farah
authors.initials: F
authors.lastname: Khalifeh
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, PO Box 11-0236, Beirut 1107 2020, Lebanon. Electronic address: ga17@aub.edu.lb.
authors.forename: George
authors.initials: G
authors.lastname: Abi Saad
keywords: Chyle leak; Parathyroidectomy; Re-exploration; Thoracic duct; Thoracic duct injury; Thyroidectomy