A Case of Post-Esophagectomy Chylothorax Successfully Treated with Octreotide after the Failure of Thoracic Duct Ligation in an Esophageal Cancer Patient
The patient was a 42-year-old male. After preoperative chemotherapy and radiation therapy for esophageal cancer in the mid-thoracic region, subtotal esophagectomy with three-field lymph node dissection was performed via a right thoracolaparotomy (the thoracic duct was preserved). Chest tube drainage...
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| Published in | The Japanese Journal of Gastroenterological Surgery Vol. 39; no. 2; pp. 164 - 169 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
The Japanese Society of Gastroenterological Surgery
2006
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0386-9768 1348-9372 |
| DOI | 10.5833/jjgs.39.164 |
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| Abstract | The patient was a 42-year-old male. After preoperative chemotherapy and radiation therapy for esophageal cancer in the mid-thoracic region, subtotal esophagectomy with three-field lymph node dissection was performed via a right thoracolaparotomy (the thoracic duct was preserved). Chest tube drainage increased suddenly on postoperative day 3.On the postoperative day 4, enteral nutrition was instituted, and the drainage fluid turned cloudy white. A diagnosis of chylothorax was made, and since the total volume of drainage fluid measured 1, 800ml and was affecting the patient's hemodynamics, surgery was performed. Ligation of the thoracic duct in the inferior mediastinum failed to stop the leakage from the superior mediastinum. The left superior mediastinum was therefore widened to localize the site of chyle leakage in the thoracic duct, and the duct was ligated distal to the site. The following day, however, a large volume of chyle again leaked from the drain, and intermittent subcutaneous ocreotide 50 μg ×3/day was instituted. On the second day of treatment, the drainage decreased markedly. Ocreotide was continued for a total of 8 days, gradually reducing the dose and then discontinued. It stopped the chyle leakage, and it became possible to discharge the patient. Chylothorax is a complication of esophagectomy that is difficult to manage. Intermittent subcutaneous ocreotide has no adverse effects and should be considered as a treatment option. |
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| AbstractList | The patient was a 42-year-old male. After preoperative chemotherapy and radiation therapy for esophageal cancer in the mid-thoracic region, subtotal esophagectomy with three-field lymph node dissection was performed via a right thoracolaparotomy (the thoracic duct was preserved). Chest tube drainage increased suddenly on postoperative day 3.On the postoperative day 4, enteral nutrition was instituted, and the drainage fluid turned cloudy white. A diagnosis of chylothorax was made, and since the total volume of drainage fluid measured 1, 800ml and was affecting the patient's hemodynamics, surgery was performed. Ligation of the thoracic duct in the inferior mediastinum failed to stop the leakage from the superior mediastinum. The left superior mediastinum was therefore widened to localize the site of chyle leakage in the thoracic duct, and the duct was ligated distal to the site. The following day, however, a large volume of chyle again leaked from the drain, and intermittent subcutaneous ocreotide 50 μg ×3/day was instituted. On the second day of treatment, the drainage decreased markedly. Ocreotide was continued for a total of 8 days, gradually reducing the dose and then discontinued. It stopped the chyle leakage, and it became possible to discharge the patient. Chylothorax is a complication of esophagectomy that is difficult to manage. Intermittent subcutaneous ocreotide has no adverse effects and should be considered as a treatment option. |
| Author | Sumi, Tetsuo Suzuki, Yoshiaki Aoki, Tatsuya Takagi, Makoto Yasuda, Yoshihiro Matsuda, Daisuke Okada, Ryosuke Lee, Jeong Sik Aoki, Toshiaki Kato, Fumiaki |
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| References | 14) 山下昭: リンパの化学的組成とリンパ内細胞. 大谷修, 加藤征治, 内野滋雄編. リンパ管. 西村書店, 新潟, 1997, p195-210 7) Buettiker V, Hug MI, Burger R et al: Somatostatin: a new therapeutic option for the treatment of chylothorax. Intensive Care Med 27: 1083-1086, 2001 1) Bolger C, Walsh TN, Tanner WA et al: Chylothorax after oesophagectomy. Br J Surg 78: 587-588, 1991 10) Markham KM, Glover JL, Welsh RJ et al: Octreotide in the treatment of thoracic duct injuries. Am Surg 66: 1165-1167, 2000 15) 北野正尚, 井原正博, 高橋隆一ほか: 先天性心疾患術後に合併した乳糜胸に対するオクトレオチドの効果. 日小児循環器会誌18: 639-644, 2002 5) Rimensberger PC, Müller-Schenker B, Kalangos A et al: Treament of a persistent postoperative chylothorax with somatostatin. Ann Thorac Surg 66: 2532-2554, 1998 8) Rosti L, Binni RM, Chessa M et al: The effectiveness of octreotide in the treatment of postoperative chylothorax. Eur J Pediatr 161: 149-150, 2002 9) Al-Zubairy SA, Al-Jazairi AS: Octreotide as a therapeutic option for management of chylothorax. Ann Pharmacother 37: 679-682, 2003 31) Cope C: Management of chylothorax via percutaneous embolization. Curr Opin Pulm Med 10: 311-314, 2004 4) Ulibarri JI, Sanz Y, Fuentes C et al: Reduction of lymphorrhagia from ruptured thoracic duct by somatosutatin. Lancet 336: 258, 1990 22) Hayashi S, Miyazaki M: Thoracic duct: visualization at nonenhanced MR lymphography initial experience. Radiology 212: 598-600, 1999 26) 藤田博文, 上坂邦夫, 濱辺豊ほか: 持続陽圧呼吸とMinomycin胸腔内注入による食道癌術後多量乳糜胸の1治験例. 外科64: 228-232, 2002 19) 神崎正人, 大貫恭正, 兼安秀人ほか: 胸腔鏡により治癒し得た肺癌術後乳糜胸の1例. JSES 3: 408-411, 1998 17) 鈎スミ子: 胸管. 大谷修, 加藤征治, 内野滋雄編. リンパ管. 西村書店, 新潟, 1997, p296-301 29) Guillem P, Billeret V, Lecomte M et al: Successful management of post-esophagectomy chylothorax/chyloperitoneum by etilefrine. Dis Esophagus 12: 155-156, 1999 21) 長田信洋, 伊藤健二, 大川恭矩: 術後乳糜胸. 小児外科19: 1569-1574, 1987 16) Robinson CLN: The management of chylothorax. Ann Thorac Surg 39: 90-95, 1985 27) 江田匡仁, 市原利彦, 朝倉貞二ほか: 99mTc-HAS-Dリンパシンチグラフィーが有用であった術後乳糜胸. 胸部外科55: 1035-1038, 2002 20) 藤田秀春: 術後乳糜胸. 臨外46: 216-217, 1991 24) 石田修: 脈管の造影診断と治療的応用. 南山堂, 東京, 1991, p287-311 3) Nakabayashi H, Sagara H, Usukura N: Effect of somatostatin on flow rate and triglyceride levels thoracic duct lymph in normal and vagotomized dogs. Diabetes 30: 440-445, 1981 25) 森田理一郎, 赤荻栄一, 鈴木有二ほか: 胸腔鏡下フィブリン糊注入により治癒し得た肺摘除術後乳糜胸の1例. 日胸外会誌38: 2465-2467, 1990 11) Collard JM, Laterre PF, Boemer F et al: Conservative treatment of postsurgical lymphatic leaks with somatostatin-14. Chest 117: 902-905, 2000 13) 菅野雅彦, 橋本貴史, 工藤圭三: ソマトスタチンアナログの有効性が示唆された食道癌術後乳糜腹水の1例. 日臨外会誌65: 366370, 2004 12) Michelet P, Embriaco N, Roch A et al: Somatostatin for the treatment of a post-oesophagectomy chylothorax. Ann Fr Anesth Reanim 23: 56-58, 2004 30) Schild H, Hirner A: Percutaneous translymphatic thoracic duct embolization for treatment of chylothorax. Rofo 173: 580-582, 2001 6) Kelly RF, Shumway SJ: Conservative management of postoperative chylothorax using somatostatin. Ann Thorac Surg 69: 1944-1945, 2000 28) 植村守, 土岐祐一郎, 石川治ほか: リピオドールリンパ管造影にて治癒した食道癌術後難治性乳糜胸水の1例. 日消外会誌38: 712, 2005 23) 西澤聡, 大杉治司, 竹村雅至ほか: リンパ管シンチグラフィーを治療方針決定に応用した食道癌術後乳糜胸の1例. 日臨外会誌64: 3044-3047, 2003 18) 花岡芳雄, 谷昌尚, 原修ほか: 術後乳糜胸の治療経験. 外科49: 703-707, 1987 2) Brazeau P, Vale W, Burgus R et al: Hypothalamic polypeptide that inhibits the secretion of immunoreactive pituitary growth hormone. Science 179: 77-79, 1973 |
| References_xml | – reference: 6) Kelly RF, Shumway SJ: Conservative management of postoperative chylothorax using somatostatin. Ann Thorac Surg 69: 1944-1945, 2000 – reference: 12) Michelet P, Embriaco N, Roch A et al: Somatostatin for the treatment of a post-oesophagectomy chylothorax. Ann Fr Anesth Reanim 23: 56-58, 2004 – reference: 10) Markham KM, Glover JL, Welsh RJ et al: Octreotide in the treatment of thoracic duct injuries. Am Surg 66: 1165-1167, 2000 – reference: 5) Rimensberger PC, Müller-Schenker B, Kalangos A et al: Treament of a persistent postoperative chylothorax with somatostatin. Ann Thorac Surg 66: 2532-2554, 1998 – reference: 25) 森田理一郎, 赤荻栄一, 鈴木有二ほか: 胸腔鏡下フィブリン糊注入により治癒し得た肺摘除術後乳糜胸の1例. 日胸外会誌38: 2465-2467, 1990 – reference: 20) 藤田秀春: 術後乳糜胸. 臨外46: 216-217, 1991 – reference: 30) Schild H, Hirner A: Percutaneous translymphatic thoracic duct embolization for treatment of chylothorax. Rofo 173: 580-582, 2001 – reference: 21) 長田信洋, 伊藤健二, 大川恭矩: 術後乳糜胸. 小児外科19: 1569-1574, 1987 – reference: 14) 山下昭: リンパの化学的組成とリンパ内細胞. 大谷修, 加藤征治, 内野滋雄編. リンパ管. 西村書店, 新潟, 1997, p195-210 – reference: 29) Guillem P, Billeret V, Lecomte M et al: Successful management of post-esophagectomy chylothorax/chyloperitoneum by etilefrine. Dis Esophagus 12: 155-156, 1999 – reference: 2) Brazeau P, Vale W, Burgus R et al: Hypothalamic polypeptide that inhibits the secretion of immunoreactive pituitary growth hormone. Science 179: 77-79, 1973 – reference: 23) 西澤聡, 大杉治司, 竹村雅至ほか: リンパ管シンチグラフィーを治療方針決定に応用した食道癌術後乳糜胸の1例. 日臨外会誌64: 3044-3047, 2003 – reference: 1) Bolger C, Walsh TN, Tanner WA et al: Chylothorax after oesophagectomy. Br J Surg 78: 587-588, 1991 – reference: 13) 菅野雅彦, 橋本貴史, 工藤圭三: ソマトスタチンアナログの有効性が示唆された食道癌術後乳糜腹水の1例. 日臨外会誌65: 366370, 2004 – reference: 16) Robinson CLN: The management of chylothorax. Ann Thorac Surg 39: 90-95, 1985 – reference: 8) Rosti L, Binni RM, Chessa M et al: The effectiveness of octreotide in the treatment of postoperative chylothorax. Eur J Pediatr 161: 149-150, 2002 – reference: 9) Al-Zubairy SA, Al-Jazairi AS: Octreotide as a therapeutic option for management of chylothorax. Ann Pharmacother 37: 679-682, 2003 – reference: 22) Hayashi S, Miyazaki M: Thoracic duct: visualization at nonenhanced MR lymphography initial experience. Radiology 212: 598-600, 1999 – reference: 27) 江田匡仁, 市原利彦, 朝倉貞二ほか: 99mTc-HAS-Dリンパシンチグラフィーが有用であった術後乳糜胸. 胸部外科55: 1035-1038, 2002 – reference: 26) 藤田博文, 上坂邦夫, 濱辺豊ほか: 持続陽圧呼吸とMinomycin胸腔内注入による食道癌術後多量乳糜胸の1治験例. 外科64: 228-232, 2002 – reference: 18) 花岡芳雄, 谷昌尚, 原修ほか: 術後乳糜胸の治療経験. 外科49: 703-707, 1987 – reference: 17) 鈎スミ子: 胸管. 大谷修, 加藤征治, 内野滋雄編. リンパ管. 西村書店, 新潟, 1997, p296-301 – reference: 11) Collard JM, Laterre PF, Boemer F et al: Conservative treatment of postsurgical lymphatic leaks with somatostatin-14. Chest 117: 902-905, 2000 – reference: 15) 北野正尚, 井原正博, 高橋隆一ほか: 先天性心疾患術後に合併した乳糜胸に対するオクトレオチドの効果. 日小児循環器会誌18: 639-644, 2002 – reference: 28) 植村守, 土岐祐一郎, 石川治ほか: リピオドールリンパ管造影にて治癒した食道癌術後難治性乳糜胸水の1例. 日消外会誌38: 712, 2005 – reference: 24) 石田修: 脈管の造影診断と治療的応用. 南山堂, 東京, 1991, p287-311 – reference: 3) Nakabayashi H, Sagara H, Usukura N: Effect of somatostatin on flow rate and triglyceride levels thoracic duct lymph in normal and vagotomized dogs. Diabetes 30: 440-445, 1981 – reference: 7) Buettiker V, Hug MI, Burger R et al: Somatostatin: a new therapeutic option for the treatment of chylothorax. Intensive Care Med 27: 1083-1086, 2001 – reference: 4) Ulibarri JI, Sanz Y, Fuentes C et al: Reduction of lymphorrhagia from ruptured thoracic duct by somatosutatin. Lancet 336: 258, 1990 – reference: 19) 神崎正人, 大貫恭正, 兼安秀人ほか: 胸腔鏡により治癒し得た肺癌術後乳糜胸の1例. JSES 3: 408-411, 1998 – reference: 31) Cope C: Management of chylothorax via percutaneous embolization. Curr Opin Pulm Med 10: 311-314, 2004 |
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| Title | A Case of Post-Esophagectomy Chylothorax Successfully Treated with Octreotide after the Failure of Thoracic Duct Ligation in an Esophageal Cancer Patient |
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