Postoperative
chylothorax after
esophagectomy is a relatively rare complication, but treatment can sometimes be complicated. We report 3 cases of
Lipiodol lymphangiography via inguinal lymph node
puncture that was effective for chyle leakage occurring after
esophagectomy. Case 1: A 67-year-old man with stage IIIA
esophageal squamous cell carcinoma underwent radical
esophagectomy by video-assisted thoracic surgery (VATS) following
neoadjuvant chemotherapy (NAC). After
enteral feeding, right
pleural effusion drainage increased sharply and changed to white color that was diagnosed as
chylothorax.
Conservative treatment was started on postoperative day (POD) 15. On POD 50, intranodal
Lipiodol lymphangiography and thoracic duct
ligation were performed, resulting in complete improvement by the next day. Case 2: A 69-year-old man with stage IIIC
esophageal cancer was treated salvage operation following chemoradiation. Postoperative
chylothorax was diagnosed on POD 6. Despite
conservative treatment, the pleural fluid volume did not decrease. Intranodal
Lipiodol lymphangiography performed on POD 13 showed contrast medium draining from the thoracic duct near the tracheal bifurcation.
Thoracotomy for thoracic duct
ligation was performed on POD 15. Thereafter, drainage from the thoracic drain decreased significantly, and the right thoracic drain was removed 4 days later. Case 3: A 65-year-old man with Stage IVA
hypopharyngeal cancer and Stage IIIA
esophageal cancer underwent total pharyngopharyngeal
esophagectomy by VATS following NAC. Postoperative
chylothorax was diagnosed on POD 7. Despite
conservative treatment, the pleural fluid volume did not decrease. Intranodal
Lipiodol lymphangiography performed on POD 19 completely visualized the thoracic duct and showed no outflow of contrast from the main thoracic duct into the mediastinum. Pleural fluid decreased remarkably after lymphangiography. Intranodal
Lipiodol lymphangiography for postoperative
chylothorax accurately visualizes flow within the thoracic duct and clearly depicts its positional relationship with other organs. Besides lymphangiography is not only helps to determine the site of chyle leakage but can also be effective for curing
chylothorax by less invasive and safer method.