Identification of Thoracic Duct Injury Site via Inguinal Subcutaneous Injection of ICG in Esophagectomy-A Case Report

Thoracic duct injury is a serious complication of esophagectomy. Anatomical diversity can induce injury when esophagectomy is performed for esophageal cancer. Thoracic duct injury can sometimes be found after chylothorax occurs as a postoperative complication. Identifying the injured site in the thoracic duct is often difficult because of intensive inflammation due to chylothorax and anatomical diversity. In this case, we precisely identified the thoracic duct and sufficiently ligated the injured site using subcutaneous injection of indocyanine green(ICG)fluorescence, after the thoracic duct embolism using lipiodol was failed. Pooled lymphatic fluid fluoresced together with the illuminated thoracic duct, and the injured site could be clearly identified. The chylothorax disappeared after thoracic duct ligation, and the patient was discharged 40 days after esophagectomy. Subcutaneous injection around the inguinal lymph nodes can be beneficial procedure to identify injured site of thoracic duct from the fluoresced thoracic duct and pooled lymphatic fluid.