Bilateral chylothorax due to retrosternal goiter in a patient with non-hodgkin’s lymphoma

Chylous pleural effusion, or chylothorax, usually results from obstruction to or disruption of the thoracic duct. Malignant etiologies are the most common cause of chylothorax, lymphoma accounting for the majority of non-traumatic chylous effusions. We report an unusual case of bilateral chylothorax associated with a retrosternal toxic multinodular goiter in a patient with non-Hodgkin’s lymphoma. An ablative dose of ¹³¹I was administered with apparent initial clinical improvement. The pathogenesis of chylothorax and therapeutic considerations are discussed.     

Acute chylous peritonitis due to acute pancreatitis

We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse. The development of chylous ascites is usually a chronic process mostly involving malignancy, trauma or surgery, and symptoms arise as a result of progressive abdominal distention. However, when accumulation of "chyle" occurs rapidly, the patient may present with signs of peritonitis. Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation, appendicitis or visceral ischemia. Less than 100 cases of acute chylous peritonitis have been reported. Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis. This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis, and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis. The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer, since, due to hypertriglyceridemia, serum amylase values appeared within the normal range. Moreover, abdominal computed tomography imaging was not diagnostic for pancreatitis. Following abdominal lavage and drainage, the patient was successfully treated with total parenteral nutrition and octreotide.     

小儿肠系膜乳糜囊肿五例诊治分析

目的探讨小儿肠系膜乳糜囊肿的临床特点、诊断及治疗方法。方法回顾性分析2005~2015年间收治的5例小儿肠系膜乳糜囊肿患儿的临床表现及治疗经过。本组男孩3例,女孩2例,年龄2~10岁,中位年龄4岁2个月,病程1 d至2年。2例表现为急腹症,术中证实囊肿压迫肠管并发肠梗阻。3例行单纯囊肿切除,2例行囊肿及受累肠管切除肠吻合。结果全部病例行手术治疗,囊内液均呈乳糜状。术后肠道功能恢复正常,原有症状消失,痊愈出院。随访6个月至5年未见明显异常,腹部B超检查未见囊肿复发。结论小儿肠系膜乳糜囊肿的主要临床表现为腹部肿块、腹胀,部分患儿以急腹症为首发症状,临床表现与囊肿位置相关。完整地手术切除囊肿及受累肠管预后良好。     

原发性乳糜反流综合征Ⅰ型一例

患者女,18岁,因外阴和右下肢肿大伴乳白色水疱3年就诊。皮肤科检查：右侧阴唇和右下肢肿胀粗大,右侧大阴唇、两侧小阴唇、阴道口以及右大腿内侧皮肤上群集和散在许多针头至粟粒大乳白色厚壁水疱,有乳白色乳糜液从阴道流出。MRI检查示下腹腔和骨盆右侧的淋巴管显著扩张,右大腿内侧皮肤和皮下组织以及阴道壁和右侧大阴唇内淋巴管扩张扭曲,但子宫未见异常。皮肤组织病理示真皮浅层的淋巴管扩张成囊状,真皮中下部可见纤维组织增生。诊断原发性乳糜反流综合征Ⅰ型。     

Chyle fistula in right cervical area after thyroid surgery

Thoracic duct injury is an infrequent (1-2.5%) but severe complication after neck surgery, leading to nutritional, metabolic and immunologic deficiencies. We report a case of a 34-year-old woman with a right thoracic duct injury after surgery of a thyroid medullar cancer effectively treated with conservative management (parenteral nutrition and intravenous somatostatin). Optimal treatment of these patients is unclear, without a clear limit between conservative and surgical treatment.     

颈廓清术后发生乳糜漏3例报告

为了探讨颈廓清术后乳糜漏发生的原因与处理原则，报告颈廓清术后发生乳糜漏３例的临床资料。其中１例为胸腔积液，２例为迟发性颈乳糜漏。１例经支持疗法治毹例手术治愈。并就乳糜漏的发生原因，早期征象，治疗方法等进行讨论。     

A systematic review of chyle leaks and their management following axillary surgery

IntroductionChyle leaks following surgery to the axilla are seldom encountered with an incidence <0.7%. Management varies with no consensus in the literature. Injury to branching tributaries of the thoracic duct may require lengthy management at significant cost to patient and clinical team. This paper aims to provide an up-to-date review to support clinical management.MethodsThe term ‘chyle’ was combined with ‘breast’ or ‘axilla.’ EMBASE, Medline and PubMed database searches were conducted. All papers published in English were included with no exclusion date limits.Results51 cases from 31 papers. All were female (mean age = 53.3yrs). 47/51 leaks were left-sided. 5/51 underwent sentinel node biopsy, 19/51 level II axillary node clearance (ANC), 23/51 level III ANC, 5/51 not specified. 59% (30/51) of leaks were identified within 2 postoperative days (mean = 3.3days). 96% initially managed conservatively: Drain = 38/51; low-fat diet = 34/51; compression bandaging = 20/51; Aspiration = 6/51. 40/51 (78%) were successfully managed conservatively, 11 patients returned to theater for secondary management. 7/11 recorded volumes >500mls/24 hrs before secondary surgery. Mean resolution time from initial surgery was 17.3days (range = 4–64days). No statistically significant difference (p = 0.72) in time to resolution between conservatively and surgically managed patients.ConclusionsChyle leaks are rarely seen following axillary surgery. Aberrant thoracic duct anatomy represents the likeliest aetiology. We advocate early recognition and tailored individual management. Conservative management with non-suction drainage, low-fat diet and axillary compression bandaging appear effective where output <500ml/24 hrs. Secondary surgical management should be considered in high chylous output (<500mls/24 hrs) patients unresponsive to conservative measures. We propose a management algorithm to aide clinicians.     

Chylous ascites in colorectal surgery: A systematic review

BACKGROUNDChylous ascites is a rare complication in colorectal surgery with limited evidence. AIMTo systematically review all available evidence to describe the incidence, clinical presentation, risk factors and management strategies.METHODSThe systematic review was performed through PubMed, MEDLINE, EMBASE and Cochrane and cross-checked up to November 2020. The data collated included: Demographics, indications (benign vs malignant), site of disease, surgical approach, extent of lymphadenectomy, day to and method of diagnosis of chylous ascites and management strategies. RESULTSA total of 28 studies were included in the final analysis (426 cases). Patient age ranged from 31 to 89 years. All except one case were performed for malignancy. Of the 426 cases, 195 were right-colonic, 121 left-colonic, 103 pelvic surgeries and 7 others. The majority were diagnosed during the same inpatient stay by recognition of typical drain appearance and increased volume. Three cases were diagnosed during outpatient visits with increased abdominal distention and subsequently underwent paracentesis. Most cases were managed successfully non-operatively (fasting with prolonged drainage, total parenteral nutrition, somatostatin analogues or a combination of these). Only three cases required surgical intervention after failing conservative management and subsequently resolved completely. Risk factors identified include: Right-colonic surgery/ tumour location, extent of lymphadenectomy and number of lymph nodes harvested. CONCLUSIONChylous ascites after colorectal surgery is a relatively rare complication. Whilst the majority of cases resolved without surgical intervention, preventative measures should be undertaken such as meticulous dissection and clipping of lymphatics during lymphadenectomy to prevent morbidity.     

大连市街头无偿献血乳糜血发生情况分析

目的 探究大连市街头无偿献血乳糜血人群分布特点.方法 选取2018年1月至2018年12月在大连市某街头采血点献血的16524人次为研究对象,使用比浊图片法判读献血群体乳糜血发生情况.比较乳糜血发生在性别、年龄、BMI、职业、婚姻状态及季节方面的分布特点.结果 16524人次街头无偿献血群体中乳糜血发生率为6.37％,...     

Prospective Identification of Chyle Leakage in Patients Undergoing Lateral Neck Dissection for Metastatic Thyroid Cancer

Background Lateral neck dissection for metastatic thyroid cancer includes the lower jugular nodes, but there has been little study of chyle leakage. We therefore prospectively examined chyle leakage that occurred during and after lateral neck dissection in treatment of thyroid cancer. Methods A total of 82 consecutive patients underwent 96 lateral neck dissections for metastatic differentiated thyroid cancer—42 in the right neck, 26 in the left neck, and 14 in both. All patients were monitored for intraoperative and postoperative chyle leakage. All postoperative drainage fluid and serum were chemically analyzed for triglycerides and cholesterol for early identification of chyle leakage. Results Intraoperative chyle leakage was observed during 5 of the 96 neck dissections (5.2%), all on the left side and all controlled by suturing chyle fistula, thus avoiding postoperative leakage. Postoperative chyle leakage was observed in 8 of the 96 neck dissections (8.3%), 5 in the right and 3 in the left neck. The mean peak triglyceride concentration of drainage fluid was significantly higher in patients with chyle leakage than in those without (309 vs 42 mg/dl, P < 0.001). To stop leakage, 2 patients underwent reoperations. Chyle leakage stopped within 5–62 days (mean 18 days) after surgery. Conclusions Chyle leakage related to lateral neck dissection for thyroid cancer is uncommon but may occur more frequently than reported previously, even in the right neck. Our findings may guide thyroid surgeons in both careful neck dissection in at-risk areas and proper postoperative management.