What is a chyle leak after surgery?
Chyle leak formation is an uncommon but serious sequela of head and neck surgery when the thoracic duct is inadvertently injured, particularly with the resection of malignancy low in the neck. The thoracic duct is the primary structure that returns lymph and chyle from the entire left and right lower half of the body.
What causes Chylous pleural effusion?
Penn Medicine researchers recently discovered that chylothorax is commonly caused by leakage of lymph from the thoracic duct into the pleural space (the space around the lungs). The thoracic duct is the largest lymphatic duct and typically transports lymph from the body to veins.
Is a chyle leak painful?
Chylothorax is a rare condition in which lymphatic fluid leaks into the space between the lung and chest wall. When this fluid builds up in the lungs, it can cause a severe cough, chest pain and difficulty breathing.
Why do chyle leaks happen?
This is also known as a chyle leak and is a type of pleural effusion. It happens when lymph (called chyle) fluid that forms in the digestive system accumulates in the pleural (lung) cavity. This can happen because of either disruption or obstruction of the thoracic duct. The lymph fluid ends up where it doesn’t belong.
How do you treat a chyle leak?
Octreotide therapy has been shown to be successful in high-volume leaks, with reported success in a 2300-mL chyle leak that persisted after 8 days of MCT diet then resolved 6 days after initiation of octreotide therapy with no adverse events.
How long does chyle leak take to heal?
Lucente and colleagues20 reported that all of their chyle fistulas resolved within 7 days when the patient was placed on a diet high in medium-chain triglycerides.
Where does chyle leak occur?
Chyle is carried around the body by lymphatic vessels, just like blood is carried around the body by blood vessels. The lymphatic system carries fluid, fats, protein and cells that fight infection. A leak can occur in the lymphatic system after surgery. This is called a chyle leak.
Can a chylous effusion cause a leak?
Chyle leaks are a rare complication; they can occur for a variety of reasons after injury to the intra-abdominal lymphatics (Table 1). Leakage may manifest as a chy- lothorax or chylous effusion (thoracic cavity); chylous ascites (peritoneal cavity); chylopericardium (cardiac cavity) or as an external draining fistula.
What are the treatment options for chyle leaks after pulmonary resection?
Most chyle leaks after pulmonary resections heal with non-operative management. Assuming the output is low, these patients can be initially managed with a MCT diet for 2 weeks. In carefully selected patients this can be done on an outpatient basis. Prior to the tube removal, patients are challenged with a fatty meal.
When is pleurodesis used to treat a chylothorax?
Surgical treatment. Pleurodesis also offers a treatment option when a malignant tumor is the cause of the chylothorax. It is employed when treatment of the tumor has not resulted in sufficient improvement, or in situations where interrupting the thoracic duct is regarded as not feasible or worthwhile.
What is the incidence of chylothorax after surgery?
Incidence data are available for only postoperative chylothorax, which can occur after almost any surgical operation in the chest. It is most often observed after esophagectomy (about 3% of cases), or after heart surgery in children (up to about 6% of cases) (1, 2).