Atypical presentation and transabdominal treatment of chylothorax complicating esophagectomy for cancer

Chylotorax is a relatively uncommon and difficult to treat complication after esophagectomy for cancer. We report a case of a young adult male who underwent neoadjuvant chemoradiationtherapy followed by Ivor-Lewis esophagectomy for a squamous-cell carcinoma of the distal esophagus. During the postoperative course the patient presented recurrent episodes of hemodynamic instability mimicking cardiac tamponade, secondary to compression of the left pulmonary vein and the left atrium by a mediastinal chylocele. Mediastinal drainage and ligation of the cisterna chyli and the thoracic duct was successfully performed through a transhiatal approach

Esophagectomy without mortality: What can surgeons do?

Introduction: Surgical resection remains the mainstay treatment for patients with localized esophageal cancer. It is, however, a complex procedure. Mortality rate used to be high, but in recent years, death rate has been reduced to below 5% in specialized centers. Methods: Outcome of esophagectomy can be improved by paying attention to (1) appropriate patient section, (2) choice of surgical techniques and their execution, and (3) optimizing perioperative care. A volume-outcome relationship is also evident. Surgeons can perform esophagectomy without mortality, but a multi-disciplinary team management is essential to achieve this goal. © 2009 The Society for Surgery of the Alimentary Tract.postprin

Chylothorax and other pleural effusions

A pleural effusion is the accumulation of fluid in the pleural space, and may represent chyle, pus, blood, transudate or other fluid. This chapter covers the pathophysiology, presentation, diagnosis and management of pleural effusions in neonates, with particular reference to the accumulation of chyle. Chylothorax is the commonest explanation for a pleural effusion in the first few days of life. It may be congenital or acquired with numerous causes. Laboratory fluid analysis, ultrasonography and plain radiography are the most important diagnostic modalities. Once diagnosed, an initial period of intestinal rest and parenteral nutrition is warranted accompanied by pleural drainage, followed by a low fat enteral feeds containing medium chain triglycerides. Nevertheless, emerging pharmacological and interventional therapies are being introduced, but surgery is reserved for when medical management fails