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Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome
Published on: September 13, 2020
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Chylothorax post transaxillary first rib resection for thoracic outlet syndrome.
Sylvie Bowden1, Mohammed Firdouse2, Graham Roche-Nagle3
1Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
BMJ Case Reports
|March 9, 2021
Summary
A rare chyle leak (chylothorax) occurred after surgery for venous thoracic outlet syndrome. Conservative treatment, including diet and rest, successfully resolved the high-output chyle fistula.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Complications
Background:
- Venous thoracic outlet syndrome (VTOS) is a condition affecting blood flow in the upper extremities.
- Surgical intervention, such as first rib resection, is a treatment option for VTOS.
- Complications following thoracic surgery can include lymphatic system injuries.
Purpose of the Study:
- To report the first documented case of high-output chyle leak following a transaxillary first rib resection for VTOS.
- To describe the successful conservative management of this rare complication.
Main Methods:
- A patient underwent a left transaxillary first rib resection for venous thoracic outlet syndrome.
- The patient subsequently developed a high-output chyle leak (chylorrhoea).
- Treatment involved conservative measures: bed rest, parenteral nutrition, and a low-fat diet.
Main Results:
- The high-output chyle leak was successfully managed with conservative therapy.
- The patient experienced complete resolution of the chylous fistula.
- Hospital stay was 18 days, with resolution prior to discharge.
Conclusions:
- Chylothorax is a rare but significant complication that can occur after transaxillary first rib resection.
- Conservative management can be effective in treating high-output chyle leaks post-surgery.
- Anomalous lymphatic anatomy may predispose patients to chylothorax after this procedure.
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