A 75-year-old male is a patient in your ICU, day three following an elective oesophagectomy.

Examine the photograph provided.

 

drain

 

a) What complication has occurred?

b) What is your management of this complication?

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College Answer

 

a) Chylothorax secondary to thoracic duct damage.

NB: Both parts needed for whole mark.

b) Conservative management with drainage, octreotide and TPN. Surgical management with pleurodesis or thoracic duct ligation

 

Discussion

 

The picture abode is of a drain with chyle in it, which was not part of the original college paper. Indeed, nobody knows what precisely the college depicted in their version.

I have attempted to provide the candidate with a picture which has in it an unambiguously creamy opaque fluid, sitting in some obvious chest drain tubing.

And yes, chylothorax is a frequent complication of oesophagectomy.

Diagnosis of chylothorax:

Management of chylothorax

References

References

Fahimi, Hossein, et al. "Current management of postoperative chylothorax." The Annals of thoracic surgery 71.2 (2001): 448-450.

Fujita, Takeo, and Hiroyuki Daiko. "Efficacy and Predictor of Octreotide Treatment for Postoperative Chylothorax After Thoracic Esophagectomy." World Journal of Surgery (2014): 1-7.

Seriff, NATHAN S., et al. "Chylothorax: diagnosis by lipoprotein electrophoresis of serum and pleural fluid." Thorax 32.1 (1977): 98-100.

Hillerdal, G. "Chylothorax and pseudochylothorax." European Respiratory Journal 10.5 (1997): 1157-1162.

Shah, Rachit D., et al. "Postesophagectomy chylothorax: incidence, risk factors, and outcomes." The Annals of thoracic surgery 93.3 (2012): 897-904.

Merigliano, Stefano, et al. "Chylothorax complicating esophagectomy for cancer: a plea for early thoracic duct ligation." The Journal of thoracic and cardiovascular surgery 119.3 (2000): 453-457.

Valentine, Vincent G., and Thomas A. Raffin. "The management of chylothorax." CHEST Journal 102.2 (1992): 586-591.

Nair, Sukumaran K., Matus Petko, and Martin P. Hayward. "Aetiology and management of chylothorax in adults." European journal of cardio-thoracic surgery 32.2 (2007): 362-369.

Hashim, Sami A., et al. "Treatment of chyluria and chylothorax with medium-chain triglyceride." New England Journal of Medicine 270.15 (1964): 756-761.