Treatment of High-Output Thoracic Chylous Fistula with Transabdominal Embolization of Cisterna Chyli: A Case Report and Review of the Literature

Osman Nuri Dilek; Oğuzhan Özşay; Ömür Ballı; Selda Gücek Hacıyanlı; Volkan Çakır; Emine Özlem Gür; Mehmet Hacıyanlı

doi:10.5152/EurJTher.2018.347

Authors

Osman Nuri Dilek Clinic of Surgery, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir https://orcid.org/0000-0002-6313-3818
Oğuzhan Özşay Clinic of Surgery, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir https://orcid.org/0000-0001-6291-2652
Ömür Ballı Clinic of Radiology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir https://orcid.org/0000-0001-6593-649X
Selda Gücek Hacıyanlı Clinic of Surgery, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir https://orcid.org/0000-0002-5956-8421
Volkan Çakır Clinic of Radiology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir https://orcid.org/0000-0003-4032-3288
Emine Özlem Gür Clinic of Surgery, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir https://orcid.org/0000-0003-2749-2220
Mehmet Hacıyanlı Clinic of Surgery, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir https://orcid.org/0000-0002-0512-1405

DOI:

https://doi.org/10.5152/EurJTher.2018.347

Keywords:

Chyle fistula, embolization, esophagus, lymphangiography, surgery

Abstract

Postoperative thoracic chylous fistula is an infrequent complication after esophageal surgery. It represents a difficult management problem due to the serious mechanical, nutritional, and immunological consequences of the constant loss of protein and lymphocytes. A 55-year-old woman sequentially developed a high-output (2500 mL/day) thoracic chylous fistula and right-sided chylothorax, after a transhiatal total esophagectomy for adenocarcinoma of the distal esophagus. In this study, we discuss the case and treatment modalities in view of the literature. Multimodal procedures including low-triglyceride diet, sclerosing agents, repeated thoracentesis, and closed thoracostomy tube drainage were applied for treatment within two months after surgery. Finally, embolization of the cisterna chyli with liquid embolic agents produced rapid clinical and radiographic improvement. The procedure of opacification, catheterization, and embolization of the cisterna chyli was successful. Percutaneous transabdominal duct embolization is a safe, effective, and minimally invasive option to treat chylous fistula.

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