DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20200272

Diaphragmatic fenestration an effective treatment for refractory postoperative chylothorax: a case report

Oluwaseun R. Akanbi, Swaminathan Vaidyanathan, Prakash Agarwal, Janeel Musthafa, Neville A. G. Solomon

Abstract


Postoperative chylothorax remains a clinical challenge to the surgeon with substantial morbidity and risk of mortality. Though an uncommon complication, it is known to complicate cardiac and non-cardiac thoracic surgeries. Conservative measures are first employed in managing this. Surgical options are adopted when the effusion is protracted, most recent of which includes diaphragmatic fenestration. A 9-year-old girl is presented who developed recurrent right chylothorax following thoracoscopic excision of a cystic lymphangioma. Following failed conservative therapy, she had thoracic duct ligation and right diaphragmatic fenestration (using fenestrated polytetrafluoroethylene patch) with satisfactory outcome. Aetio-pathologic mechanisms implicated in postoperative chylothorax have been classified into traumatic (iatrogenic injury to the thoracic duct or its branches) and non-traumatic. With initial conservative measures (repeated pleural aspirations and intercostal drainage, medium chain triglyceride/ low fat feeds or alternatively, fasting and total parenteral nutrition) spontaneous closure remains unpredictable. Diaphragmatic fenestration when employed resulted in faster resolution of effusion and earlier commencement of enteral feeding with no significant complication. Diaphragmatic fenestration is effective and safe for treating refractory post-operative chylothorax.


Keywords


Postoperative chylothorax remains a clinical challenge to the surgeon with substantial morbidity and risk of mortality. Though an uncommon complication, it is known to complicate cardiac and non-cardiac thoracic surgeries. Conservative measures are first

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References


Savla JJ, Itkin M, Rossano JW, Dori Y. Post-operative chylothorax in patients with congenital heart disease. J Am Coll Cardiol. 2017 May 8;69(19):2410-22.

Chan EH, Russell JL, Williams WG, Van Arsdell GS, Coles JG, McCrindle BW. Postoperative chylothorax after cardiothoracic surgery in children. Annal Thora Surg. 2005 Nov 1;80(5):1864-70.

Talwar S, Agarwala S, Mittal CM, Choudhary SK, Airan B. Pleural effusions in children undergoing cardiac surgery. Annal Pediatr Cardiol. 2010 Jan;3(1):58.

Fahimi H, Casselman FP, Mariani MA, van Boven WJ, Knaepen PJ, van Swieten HA. Current management of postoperative chylothorax. Annal Thora Surg. 2001 Feb 1;71(2):448-50.

Kumar TS, Balduf K, Boston U, Knott-Craig C. Diaphragmatic fenestration for refractory chylothorax after congenital cardiac surgery in infants. J Thora Cardio Surg. 2017 Dec 1;154(6):2062-8.

Robinson CL. The management of chylothorax. Annal Thora Surg. 1985 Jan 1;39(1):90-5.

Talwar S, Das A, Choudhary SK, Airan B. Diaphragmatic fenestration for resistant pleural effusions after univentricular palliation. World J Pediatr Cong Heart Surg. 2016 Mar;7(2):146-51.

Christofe NM, Pessotti CF, Paiva L, Jatene IB. Incidence and Treatment of Chylothorax in Children Undergoing Corrective Surgery for Congenital Heart Diseases. Braz J Cardio Surg. 2017 Oct;32(5):390-3.

Talwar S, Choudhary SK, Mukkannavar SB, Airan B. Diaphragmatic fenestration for resistant pleural effusions after the Fontan operation. J Thora Cardio Surg. 2012 Jan 1;143(1):244-5.

Durairaj M, Sharma R, Choudhary SK, Bhan A, Venugopal P. Diaphragmatic fenestration for resistant pleural effusions after univentricular repair. Annal Thora Surg. 2002 Sep 1;74(3):931-2.