Radiotherapy in the Treatment of High Volume Chylous Fistula Following Hepatectomy: Case Report and Review of the Literature

Abstract

Lymphatic injury is common in surgical procedures, but only 1-11% of cases present with chylous fistula. Although high volume chylous fistula is a rare condition after liver resection, serious life-threatening complications such as empyema and peritonitis secondary to severe mechanical, nutritional and immunological disorders due to protein loss may accompany this condition. Here, we report a 58-year-old male patient with Klatskin tumor (Bismuth-Corlette, 3A) who had high volume chylous fistula after right hepatectomy. In spite of medical treatment (fat-free diet, somatostatin) and tube drainage for 4 weeks, daily chylous fistula ranged between 600-1800 cc/day. Due to the prolonged drainage, low-dose radiotherapy was applied to the patient. The patient underwent fractionated radiotherapy protocol at a daily dose of 150 cGy (total 1200 cGy) for 8 days. The drainage decreased to 150 cc on day 1, than to 50 cc on day 3 and the drain was removed on day 5. The patient has been under follow up without any problem for 18 months. Several interventional and surgical multimodal procedures have been described in the literature for the treatment of refractory chylous fistulas. There are very few studies on radiotherapy in the literature. We believe that low-dose fractionated radiotherapy may be an alternative treatment modality for refractory cases.

Keywords

• Chylous fistula
• complication
• hepatectomy
• liver
• radiotherapy