Chylothorax Following Thoracolumbar Corpectomy: Successful Conservative Management With Octreotide: A Case Report

An 84-year-old woman developed delayed-onset neurological deficits due to a T12 osteoporotic vertebral fracture. She underwent anterior corpectomy and reconstruction of the T12 vertebral body via a retropleural approach. A standard surgical drain was placed and removed on postoperative day (POD) 7. Thereafter, progressive left-sided pulmonary infiltrates were observed. On POD 14, a chest drain was reinserted due to increasing pleural effusion. The drainage fluid appeared turbid yellow, and pleural fluid analysis showed a triglyceride level of 117 mg/dL, consistent with a diagnosis of chylothorax. Despite the initiation of a fat-restricted diet, chyle output persisted. On POD 30, octreotide was initiated at 100 µg subcutaneously three times daily for 6 days. The drainage ceased by the third day of treatment. This case highlights the possibility of chylothorax even in procedures that do not involve the mediastinum. Injury to an aberrant thoracic duct at the thoracolumbar junction may explain this rare postoperative complication. Octreotide therapy was effective in resolving the chyle leak after conservative dietary management failed. Chylothorax can occur after retropleural approaches to the thoracolumbar spine. Awareness of this rare complication and prompt initiation of medical treatment, including somatostatin analogues such as octreotide, may allow successful nonoperative management.