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 CASE REPORT
Year : 2004  |  Volume : 50  |  Issue : 1  |  Page : 57-59

Thoracoscopic management of thoracic duct injury: Is there a place for conservatism?


1 Departments of Surgical disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029, India
2 Departments of Anaesthesia, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029, India

Correspondence Address:
A Kumar
Departments of Surgical disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029
India
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Source of Support: None, Conflict of Interest: None


PMID: 15048002

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Thoracic duct injury is a rare but serious complication following chest surgeries and major neck dissections. Clinically, it can present as cervical chylous fistula, chylothorax or chylopericardium. Without treatment, the mortality is up to 50% and thus, early aggressive therapy is indicated. Traditional conservative management includes low-fat diet, parenteral nutrition, careful monitoring of fluid and electrolytes, and drainage of the neck wound or chylothorax. Patients with failed conservative management require definitive treatment in the form of ligation of the thoracic duct, which has traditionally been done by thoracotomy. The advent of Video-Assisted-Thoracoscopic-Surgery (VATS) over the last decade has changed the approach towards the management of numerous chest diseases. Thoracoscopic ligation of the thoracic duct has also been reported. We report herein a case of postoperative cervical chylous fistula managed successfully by VATS thoracic duct ligation and present a systematic analysis of the English literature to highlight the current trends in the management of thoracic duct injury.






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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow