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1.
BMJ Case Rep ; 14(9)2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34588205

RESUMO

Neonatal chylothorax is a rare presentation leading to significant respiratory distress, thus requiring timely diagnosis. A preterm neonate was resuscitated and ventilated, following which she clinically improved but subsequently developed respiratory distress with a right-sided pleural effusion. Interestingly, thoracentesis fluid appeared 'milky' with elevated triglycerides and lymphocytes, suggesting chylothorax. As fluid triglyceride level was lower than the established diagnostic criterion for chylothorax (1.24 mmol/L), a high fluid-to-serum triglyceride ratio was used as a surrogate diagnostic marker, later confirmed by lipoprotein electrophoresis. As observed in the index patient, a critically ill neonate would have a lower-than-average fat intake leading to less chylomicron production, thus lower triglyceride levels in chyle than expected, which may still fail to meet the amended cut-off limit. This case highlights the challenges in diagnosing neonatal chylothorax due to the lack of age-specific triglyceride levels in chyle and low oral fat intake in critically ill patients.


Assuntos
Quilo , Quilotórax , Derrame Pleural , Quilotórax/diagnóstico , Quilotórax/etiologia , Dieta com Restrição de Gorduras , Exsudatos e Transudatos , Feminino , Humanos , Recém-Nascido , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia
2.
J Coll Physicians Surg Pak ; 30(7): 849-851, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34271790

RESUMO

Injury of the lymphatic trunk during abdominal aortic surgery causes leakage of chyle into the peritoneum, resulting in chylous ascites. A 53-year male, who underwent aortobifemoral bypass surgery for Leriche syndrome in our clinic, presented to the Emergency Department two months postoperatively, with complaints of abdominal discomfort, reduced appetite and weight loss. Computed tomography imaging and ultrasound of the abdomen revealed a retroperitoneal fluid collection. The patient was admitted and treated with percutaneous drainage of the chylous ascites, total parenteral nutrition (TPN) of a low fatty diet containing medium-chain triglycerides (MCT), and intravenous antibiotics. He was discharged after three weeks of treatment. This case report is an example of a rare complication that may occur after abdominal aortic surgery; and enables us to review treatment options for the management of chylous ascites. Key Words: Chyle,  Ascites, Abdominal aortic surgery.


Assuntos
Quilo , Ascite Quilosa , Ascite Quilosa/etiologia , Ascite Quilosa/terapia , Drenagem , Humanos , Masculino , Nutrição Parenteral Total , Complicações Pós-Operatórias
3.
Ann R Coll Surg Engl ; 103(7): e231-e233, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192489

RESUMO

Chyle leak is a rare complication in colorectal surgery. It occurs due to disruption of the lymphatic drainage network in the abdomen or retroperitoneum. We describe the first reported case of chyle leak following total colectomy for inflammatory bowel disease. Our patient underwent total colectomy for severe ulcerative colitis not responsive to medical treatment. Four days postoperatively, a milky fluid was noted in the drainage bag. Analysis of the fluid confirmed chyle. The patient remained well and was successfully managed conservatively with a fat-free elemental diet and was discharged from hospital on day 12 postoperatively. A review of the literature suggests that conservative management with dietary modification is a common and effective management strategy; however, medical and surgical options exist for refractory cases.


Assuntos
Quilo , Colectomia/efeitos adversos , Colite Ulcerativa/cirurgia , Dieta com Restrição de Gorduras , Complicações Pós-Operatórias/diagnóstico , Adulto , Tratamento Conservador/métodos , Drenagem , Feminino , Humanos , Complicações Pós-Operatórias/dietoterapia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
BMJ Case Rep ; 14(4)2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827873

RESUMO

A previously well 36-year-old woman presented with a 2-day history of a tender left-sided neck mass associated with left-sided otalgia and odynophagia. On examination, there was a diffuse, tender swelling of the left anterior triangle of the neck with extension onto the anterior chest wall. Ultrasound and CT scans of the neck revealed extensive inflammatory changes in the soft tissues of the neck and a chest X-ray showed blunting of both costophrenic angles. A diagnostic pleural aspiration was subsequently performed and yielded chyle. The patient was commenced on total parenteral nutrition and placed on a low-fat diet; symptoms completely resolved within 5 days, and at follow-up at 6 weeks, there were no further episodes or complications. Bilateral spontaneous chylothorax is a rarely reported phenomenon in the literature; it has been reported in females following the possibility of minor physical exercise such as stretching or hyperextension of the neck.


Assuntos
Quilo , Quilotórax , Adulto , Quilotórax/diagnóstico por imagem , Quilotórax/etiologia , Feminino , Humanos , Pescoço/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia
6.
BMJ Case Rep ; 14(3)2021 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-33685908

RESUMO

We present a patient who developed high output chyle leak post left transaxillary first rib resection for venous thoracic outlet syndrome. The high output chylorrhoea was successfully treated by conservative measures, bed rest, parenteral nutrition and low-fat diet. The patient was discharged after an 18-day hospital stay with a complete resolution of his chylous fistula prior to discharge. This is the first documented chylothorax post transaxillary first rib resection likely due to anomalous chyle anatomy.


Assuntos
Quilo , Quilotórax , Síndrome do Desfiladeiro Torácico , Quilotórax/etiologia , Quilotórax/cirurgia , Humanos , Costelas/cirurgia , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/etiologia , Síndrome do Desfiladeiro Torácico/cirurgia , Resultado do Tratamento
7.
J Laryngol Otol ; 135(4): 355-358, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33785086

RESUMO

OBJECTIVE: This study aimed to analyse the results of chyle fistula testing using the SD LipidoCare system in patients who had undergone neck dissections performed in our hospital in 2019. METHOD: Sixty patients who underwent neck dissections from March 2019 to November 2019 were identified based on their medical records. RESULTS: Post-operative chyle fistulas were observed in 3 of 60 patients (5 per cent). All patients who developed chyle fistulas had undergone left-sided neck dissections. Within 3 minutes, the SD LipidoCare test had produced triglyceride results of 49, 56 and 207 mg/dl in the three patients. The remaining 57 patients measured 'low' for triglycerides on the SD LipidoCare test system. CONCLUSION: The SD LipidoCare test quickly and accurately diagnosed chyle fistulas in patients who had undergone neck dissections. All patients improved with conservative treatment following the early diagnosis of chyle fistulas.


Assuntos
Fístula/diagnóstico , Testes Hematológicos/instrumentação , Esvaziamento Cervical/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Triglicerídeos/análise , Adulto , Quilo , Diagnóstico Precoce , Feminino , Testes Hematológicos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/métodos , Reprodutibilidade dos Testes
8.
J Vasc Interv Radiol ; 32(6): 896-900, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33689836

RESUMO

Chyluria is the leakage of intestinal lymph (chyle) into the urine. Novel lymphatic intervention techniques, such as interstitial lymphatic embolization, proved to be a useful treatment option for chyluria. However, one of the challenges of this approach is the difficulty in identifying connections between the lymphatic system and kidney collecting system. Here, embolization of the abnormal lymphatic connection through retrograde thoracic duct access in 3 chyluria patients is introduced.


Assuntos
Quilo , Embolização Terapêutica , Embucrilato/administração & dosagem , Doenças Linfáticas/terapia , Ducto Torácico , Adulto , Idoso , Quilo/diagnóstico por imagem , Feminino , Humanos , Doenças Linfáticas/diagnóstico por imagem , Doenças Linfáticas/urina , Linfografia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Ducto Torácico/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia de Intervenção
10.
Dis Esophagus ; 34(11)2021 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33723611

RESUMO

BACKGROUND: Chyle leakage is an uncommon but potentially life-threatening complication following esophageal resections. The optimal management strategy is not clear, with a limited evidence base. METHODS: Searches were conducted up to 31 December 2020 on MEDLINE, Embase, and Web of Science for randomized trials or retrospective studies that evaluated the management of chyle leakage following esophageal resection. Two authors independently screened studies, extracted data, and assessed for bias. The protocol was prospectively registered on PROSPERO (CRD: 42021224895) and reported in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. RESULTS: A total of 530 citations were reviewed. Twenty-five studies, totaling 1016 patients met the inclusion criteria, including two low-quality clinical trials and 23 retrospective case series. Heterogeneity of study design and outcomes prevented meta-analysis. The overall incidence of chyle leak/fistula was 3.2%. Eighteen studies describe management of chyle leaks conservatively, 17 by surgical ligation of the thoracic duct, 5 by pleurodesis, and 6 described percutaneous lymphangiography with thoracic duct embolization or disruption. CONCLUSIONS: The evidence base for optimal management of chyle leakage postesophagectomy is lacking, which may be related to its low incidence. There is a paucity of high-quality prospective studies directly comparing treatment modalities, but there is some low-certainty evidence that percutaneous approaches have reduced morbidity but lower efficacy compared with surgery. Further high-quality, prospective studies that compare interventions at different levels of severity are needed to determine the optimal approach to treatment.


Assuntos
Quilo , Quilotórax , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Ducto Torácico
11.
Head Neck ; 43(6): 1823-1829, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33586824

RESUMO

BACKGROUND: Thoracic duct injury is a rare complication of head and neck surgery. Thoracic duct embolization (TDE) has been proposed to manage postoperative chyle leaks. METHODS: Twelve patients who underwent lymphangiography for a chyle leak after head and neck surgery (M:F = 5:7, mean 55 years) were retrospectively reviewed. Lymphangiographic findings, technical success, complications, and clinical outcomes were analyzed. RESULTS: Chyle leak was identified and TDE attempted in 11 of 12 patients. Three patients required repeat TDE. Technical success of TDE was 86% (12/14). Clinical success for patients with technically successful TDE was 90% (9/10). Median time until drain removal was 2.1 days in nine patients with clinical success. Two major complications were encountered, chylothorax after initial TDE, requiring additional TDE and in one case surgical TD ligation. CONCLUSIONS: TDE is a safe treatment for chyle leaks after head and neck surgery with high technical and clinical success rates.


Assuntos
Quilo , Quilotórax , Embolização Terapêutica , Neoplasias de Cabeça e Pescoço , Quilotórax/diagnóstico por imagem , Quilotórax/etiologia , Quilotórax/terapia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Linfografia , Estudos Retrospectivos , Ducto Torácico/diagnóstico por imagem , Ducto Torácico/cirurgia , Resultado do Tratamento
12.
In Vivo ; 35(2): 1271-1276, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33622930

RESUMO

BACKGROUND/AIM: Useful prophylaxes of chyle leak (CL) after pancreatic surgery have not been established. The aim of the study was to identify an early clinical predictor for CL. PATIENTS AND METHODS: Fifty-five patients who underwent subtotal stomach preserved pancreaticoduodenectomy (SSPPD) were included. Clinical factors associated with postoperative CL were evaluated. RESULTS: Eleven patients (20%) developed a CL after SSPPD. Shorter operative time, absent pancreatic fistula, and triglyceride output volume at postoperative day (POD) two were independent risk factors for CL. The receiver operating characteristics curve of the daily triglyceride output volume at POD two indicated a cut-off point of 177 mg (AUC=0.782; p=0.004; 95% CI=0.639-0.925). CL was significantly associated with prolonged postoperative hospital stay in patients who did not develop a pancreatic fistula (p=0.003). CONCLUSION: Daily triglyceride output volume of >177 mg at POD two may be a predictor of CL following pancreaticoduodenectomy.


Assuntos
Quilo , Pancreaticoduodenectomia , Drenagem , Humanos , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Triglicerídeos
13.
Pediatr Radiol ; 51(9): 1762-1765, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33638694

RESUMO

Chyluria is characterized by chyle in the urinary tract and often presents as milky-white urine. We present a case of chyluria from a lymphatic malformation in a 13-year-old boy diagnosed using dynamic intranodal contrast-enhanced magnetic resonance (MR) lymphangiography. This report demonstrates the utility of intranodal lymphangiography and interstitial lymphatic embolization to treat a pediatric patient presenting with persistent chyluria. Glue migration into the urinary collecting system is a potential complication of this procedure that can be mitigated by adjusting the n-butyl cyanoacrylate dilution with Lipiodol.


Assuntos
Quilo , Embolização Terapêutica , Nefropatias , Vasos Linfáticos , Adolescente , Criança , Humanos , Linfografia , Masculino , Urina
14.
ANZ J Surg ; 91(3): 355-360, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33459512

RESUMO

BACKGROUND: Chyle leak (CL) is an uncommon complication of pancreatico-duodenectomy (PD). Its incidence, risk factors, and effect on prognosis are not well described and optimum management remains debated. This study aims to calculate incidence of CL following PD and identify risk factors. Following a literature review, we have proposed a management algorithm. METHODS: This is a retrospective review of all patients who underwent PD between January 2006 and April 2020 at a tertiary hepatopancreaticobiliary unit in the UK. The following data were obtained: age, gender, American Society of Anesthesiologists grade, body mass index, co-morbidities, duration of surgery, tumour histology, length of stay and mortality. RESULTS: A total of 560 patients were included. Seventeen developed CL (3.04%). Median age was 64 years (range 50-81). Sixteen (94.1%) patients still had their surgical drain in at the time of CL diagnosis. One (5.9%) did not and had free intra-abdominal fluid on computed tomography; a diagnosis was made after an ultrasound-guided drain had been inserted. CL patients were more likely to have higher body mass index (mean 30.5 kg/m2 (range 17-43) versus 26.7 kg/m2 (22-38)) (P = 0.02) and longer duration of operation (mean 6.2 h (range 4.3-9.0) versus 5.6 (3.0-11.0)) (P = 0.03). All cases of CL resolved without operative intervention. CL did not affect length of stay (median 10 days (range 4-41) versus 11 (4-34)). CONCLUSIONS: In our series, 3.04% of patients who underwent PD developed CL. No patients required a return to theatre, and none had CL recurrence.


Assuntos
Quilo , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Anastomose Cirúrgica , Humanos , Pessoa de Meia-Idade , Pancreatectomia , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
15.
Ir J Med Sci ; 190(3): 1111-1116, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33040261

RESUMO

Chyle leakage from the thoracic duct or cisterna chyli is a relatively rare complication of oesophageal cancer surgery. The majority of cases settle with conservative measures, but high volume leaks may be refractory and result in significant morbidity and require intervention with reoperation or embolization. In the experience of this high-volume centre over the last decade, 3 (0.5%) patients required reoperation and ligation of the thoracic duct; for the so-called type III leaks, interventional radiological approaches were not considered. This article is built around two recent cases, where interventional radiology to embolize and disrupt complex fistulae was successfully performed. The lessons from this experience will change practice at this centre to initial lymphangiography with a view to embolization or disruption of thoracic duct and cisterna chyli leaks as first line therapy for type III chyle leaks, with surgery reserved for where this fails.


Assuntos
Quilo , Quilotórax , Neoplasias Esofágicas , Quilotórax/diagnóstico por imagem , Quilotórax/etiologia , Quilotórax/terapia , Neoplasias Esofágicas/cirurgia , Humanos , Linfografia , Ducto Torácico/diagnóstico por imagem , Ducto Torácico/cirurgia
16.
Ann Surg Oncol ; 28(7): 3963-3972, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33263829

RESUMO

BACKGROUND: Chyle leak is an uncommon complication following esophagectomy, accounting for significant morbidity and mortality; however, the optimal treatment for the chylothorax is still controversial. OBJECTIVE: The aim of this study was to evaluate the incidence, management, and outcomes of chyle leaks within a specialist esophagogastric cancer center. METHODS: Consecutive patients undergoing esophagectomy for esophageal cancers (adenocarcinoma or squamous cell carcinoma) between 1997 and 2017 at the Northern Oesophagogastric Unit were included from a contemporaneously maintained database. Primary outcome was overall survival, while secondary outcomes were overall complications, anastomotic leaks, and pulmonary complications. RESULTS: During the study period, 992 patients underwent esophagectomy for esophageal cancers, and 5% (n = 50) of them developed chyle leaks. There was no significant difference in survival in patients who developed a chyle leak compared with those who did not (median: 40 vs. 45 months; p = 0.60). Patients developing chyle leaks had a significantly longer length of stay in critical care (median: 4 vs. 2 days; p = 0.002), but no difference in total length of hospital stay. CONCLUSION: Chyle leak remains a complication following esophagectomy, with limited understanding on its pathophysiology in postoperative recovery. However, these data indicate chyle leak does not have a long-term impact on patients and does not affect long-term survival.


Assuntos
Quilo , Neoplasias Esofágicas , Neoplasias Gástricas , Fístula Anastomótica/etiologia , Causalidade , Dissecação , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Humanos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
18.
J Coll Physicians Surg Pak ; 30(11): 1220-1222, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33222745

RESUMO

Chylothorax is the accumulation of chyle in the pleural cavity due to obstruction or injury arising in the thoracic duct or its large branches. In more than 50% of patients diagnosed with chylothorax, the etiology consists of malignant diseases; and among these, lymphomas are the most common cause, accounting for 60% of cases. We report a case of a 37-year male with T-cell lymphoma who presented with bilateral pleural effusion; pleural fluid analysis confirmed chylothorax. A solid lymph node was detected in the left zone 4 on neck ultrasonography. Tru-cut biopsy was done and reported as T-cell lymphoma. The cytology was consistent with Class V (Malignant) T-cell lymphoma infiltration. Bilateral chylothorax, a complication of T-cell lymphoma, is a rare presentation of this disease. Our patient was diagnosed rapidly with both chylothorax and lymphoma. We started the treatment immediately and saved his life. Key Words: Chyle, Chylothorax, Lymphoma.


Assuntos
Quilo , Quilotórax , Linfoma de Células T , Derrame Pleural , Quilotórax/etiologia , Humanos , Linfoma de Células T/complicações , Linfoma de Células T/diagnóstico , Masculino , Ducto Torácico/diagnóstico por imagem
19.
Rozhl Chir ; 99(10): 427-437, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33242960

RESUMO

The spectrum of causes of chylothorax is wide, including an injury to the thoracic duct in various thoracosurgical procedures, especially in esopha-geal, lung and heart surgery. Late diagnosis or inadequate treatment of chylothorax still has a high rate of morbidity and mortality. This is mainly related to high losses of chyle which is rich in minerals, plasma proteins, fats and lymphocytes. The most serious effects are mineral breakdown, malnutrition and immunodeficiency. Early diagnosis and adequate therapy are essential. The strategy is based on the type of primary operation, the volume of chyle secretion and its duration. The authors present an overview of the issue of chylothorax from its etiology of origin to its anatomy, physiology, pathophysiology, symptomatology, diagnosis and therapy.


Assuntos
Quilo , Quilotórax , Quilotórax/diagnóstico , Quilotórax/etiologia , Quilotórax/terapia , Humanos , Ligadura , Ducto Torácico
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