Delayed Chyle Leak Following Anterior Cervical Spinal Surgery: A Case Report and Management Algorithm
Kyle Mueller1, Hasan R Syed1, Jay W Rhee2
1Neurosurgery, Medstar Georgetown University Hospital.
Cureus
|June 17, 2017
Summary
Delayed thoracic duct injury is a rare complication of anterior cervical spine surgery. This case highlights conservative management with diet and octreotide for a postoperative chyle leak.
Area of Science:
- Neurosurgery
- Thoracic Surgery
- Surgical Complications
Background:
- Anterior cervical spine surgery, including anterior cervical corpectomy and fusion (ACCF), is a common procedure.
- Injury to the thoracic duct is an infrequent complication during anterior cervical spine surgery.
- Delayed presentation of chyle leak following ACCF has not been previously documented.
Observation:
- A 59-year-old female with a history of multiple neck surgeries underwent ACCF.
- Postoperative day one, the patient exhibited symptoms indicative of a thoracic duct injury, despite no intraoperative findings.
- The patient's condition was managed conservatively.
Findings:
- Conservative management included a low-fat diet and octreotide administration.
- The patient's symptoms resolved with the implemented conservative treatment.
- This case represents a unique presentation of delayed thoracic duct injury post-ACCF.
Implications:
- Spine surgeons should maintain a heightened awareness of potential thoracic duct injury during anterior cervical approaches, particularly to lower cervical and upper thoracic levels.
- Early recognition and conservative management strategies, including dietary modifications and octreotide, can be effective for delayed chyle leaks.
- This case contributes to the literature by documenting a rare complication and offering insights into its management.
