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. CONCLUSION: The use of somatostatin analog can increase the success of conservative management of thoracic duct fistulae.