A Rare Case of Right Thoracic Duct Variant: Multimodal Approach to Bilateral Chyle Leak

Chyle leak is a rare complication of head and neck surgeries, usually on the left side. Bilateral chyle leaks, especially involving an unusual right thoracic duct variant are extremely rare.This report details a 74-year-old male with well-differentiated squamous cell carcinoma of the larynx who underwent total laryngectomy, total thyroidectomy and bilateral neck dissection. A left-sided chyle leak was identified intraoperatively and repaired. Postoperatively, the patient developed a bilateral chyle leak, with the right sided leak increasing despite conservative management. Surgical exploration revealed a high-riding right thoracic duct with multiple puncture sites. An attempt at lymphangiography confirmed an anatomic variant of the right thoracic duct and embolisation to address it was unsuccessful. The chyle leak slowly resolved by day 13 and the patient was discharged well. This case highlights the challenges posed by anatomical variations of the thoracic duct, which can complicate the management of chyle leaks. The report underscores the importance of considering anatomical variations during surgery to minimise complications and improve postoperative outcomes.