The management of chylous fistula following total thyroidectomy with neck dissection – Case report and literature review

Abstract

A 63-year old female patient was admitted due to the medullary thyroid cancer. After carefully physical examination and diagnostic procedures patient was qualified for surgery. Total thyroidectomy with lymph nodes dissection was performed. During surgery chyle leak was observed from thoracic duct, which was identified and ligated. The postoperative course was complicated by bilateral chylothorax with concomitant dyspnoea and chest pain.Currently there is no explicit standard procedure for the management of chylous fistulas. This rare surgical complication may be treated both in the conservative as well as invasive manner. The therapy in this patient consisted of initiation of total parenteral nutrition (TPN), repeated pleural drainage, whereas oral diet was reintroduced in the later course of the treatment.The treatment proved successful. The volume of drained fluid reduced gradually, and after a week from the diagnosis the fistula closed, and the patient was discharged home.Further randomised studies are required to establish guidelines for the therapy of such complication.

Keywords

• Chylous fistula
• Chyle leak
• Thyroidectomy
• Neck dissection introduction