Bilateral thoracic duct ligation for persisting postoperative chylothorax
Benoît Rouiller1, Jon A Lutz1, Gregor J Kocher1
1Department of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Interactive Cardiovascular and Thoracic Surgery
|October 22, 2020
Summary
Persistent postoperative chylothorax can occur due to anatomical variations. A patient’s left thoracic duct was successfully ligated using video-assisted thoracic surgery after right-sided ligation failed.
Area of Science:
- Thoracic Surgery
- Medical Imaging
- Anatomy
Background:
- Chylothorax, a rare complication post-thoracic surgery, involves the accumulation of lymphatic fluid in the pleural space.
- Persistent chylothorax often necessitates re-intervention, posing significant clinical challenges.
Observation:
- A patient presented with persistent chylothorax despite initial surgical management.
- Computed tomography lymphangiography revealed a patent left thoracic duct, indicating an anatomical variation.
Findings:
- The initial right supradiaphragmatic thoracic duct ligation was technically successful but insufficient to resolve chylothorax.
- Anatomical variation of a patent left thoracic duct was identified as the cause of persistent chylothorax.
Implications:
- This case highlights the importance of advanced imaging in diagnosing persistent chylothorax.
- Video-assisted thoracic surgery offers a minimally invasive approach for re-ligating aberrant thoracic ducts.
- Recognizing thoracic duct anatomical variations is crucial for successful surgical management of chylothorax.
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