Delayed concurrent chylothorax and chyloperitoneum: report of a case after an old blunt trauma

Area of Science:

• Thoracic Surgery
• Pediatric Surgery
• Gastrointestinal Surgery

Background:

• Chylothorax, characterized by chyle-rich fluid in the pleural space, presents a significant clinical challenge, particularly when refractory to initial treatments.
• Mediastinal cysts can cause delayed complications, including persistent chylothorax, necessitating advanced diagnostic and therapeutic approaches.

Observation:

• A 15-year-old male presented with a 40-day history of right chylothorax and respiratory distress, unresponsive to conventional management.
• Computed Tomography revealed a large left posterior mediastinal cyst with left pleural effusion, complicating the initial right-sided presentation.
• Exploratory laparotomy identified chyloperitoneum and confirmed the need for thoracic duct intervention.

Findings:

• Initial right thoracotomy and thoracic duct ligation failed to resolve the chylothorax, which worsened post-operatively.
• Transabdominal ligation of the thoracic duct below the diaphragm proved effective, resolving right chylothorax within 1-2 days.
• Left chylous effusion gradually decreased, with complete resolution achieved 46 days post-laparotomy, and the patient showed excellent recovery at one-year follow-up.

Implications:

• This case highlights a unique presentation of a thoracic duct cyst leading to delayed chylothorax and chyloperitoneum, a combination not previously reported.
• Transabdominal thoracic duct ligation is presented as a viable and effective surgical option for complex and refractory chylothorax cases.
• The successful management underscores the importance of considering rare anatomical anomalies and adapting surgical strategies for challenging pediatric thoracic conditions.