Chylothorax as a complication of aortocoronary bypass. Two case reports and a review of the literature.

Iatrogenic chylothorax is a well-recognized complication following thoracic surgery, but is a rare occurrence after aortocoronary bypass. Only two cases have been previously reported. Two additional cases from our hospital are presented. All four male patients responded to conservative management within two weeks of initiation of treatment. Only 12 cases of chylothorax following median sternotomy have been reported (nine women and three men). Five of the nine women required surgical exploration after a course of unsuccessful management ranging from 14 to 26 days. The cause of the chylothorax was considered to be injury to lymphatic collaterals in the anterior mediastinum, which resulted in a retrograde chyle flow; the main duct remained intact. This article reviews the normal anatomy of the thoracic duct and variations of chylothorax, and describes the mechanism of injury in aortocoronary bypass, the prevention of this complication, and the results of treatment.

Mesenteric venous thrombosis--1911 to 1984.

The objective of this study was to identify those patients in whom mesenteric venous thrombosis (MVT) is likely to develop and to review the pathophysiology, clinical presentation, diagnostic modalities, and patient outcome. We present a review of the literature from 1911 to 1984 with respect to 372 patients with MVT, including five of our own patients. Data on 99 of these patients were obtained from autopsy reports and were not included in the study. This disease is common in the sixth and seventh decades of life, with 81% of these older patients having associated illnesses. MVT involves segments of the small bowel, but rarely of the colon, with hemorrhagic infarcts rather than gangrene. This disease does not conform to a pattern, although a prodromal period of days or weeks of abdominal pain (which is usually out of proportion to physical findings), marked leukocytosis, and dehydration are all highly suggestive of MVT. Serosanguineous fluid obtained by means of peritoneal tap is a useful diagnostic tool. A high index of suspicion, early diagnosis, and prompt surgical intervention with the addition of anticoagulants seems to improve survival and reduce recurrence.