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Somatostatin analog treatment of a cervical thoracic duct fistula
Carl N Valentine1, Roberto Barresi, Richard A Prinz
1Department of General Surgery, 785 Jelke Building, Rush-Presbyterian-St. Luke's Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612, USA.
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.