Successful salvage for the intractable massive chylous leakage in a cirrhotic patient



Introduction

Iatrogenic chylous leakage (CL) is a rare but potentially life-threatening complication after neck surgery. In cirrhotic patient, the massive CL is even more intractable and extremely dangerous due to portal hypertension. 

Case Report

A 54-year-old liver cirrhotic patient had milky fluid leakage from left neck drainage tube after neck dissection surgery and hypopharyngeal cancer ablation. Electrolyte imbalance and shock status were reported when conservative managements and exploratory surgical repair failed to terminate the leakage. 

Diagnosis

Massive CL up to >5 L/day was recorded on the post-operative day (POD) 9.

 

Treatment

A triangular-shaped pectoralis major (PM) muscle was designed to repair the lymph nodes dissected defect over left neck. 

Discussion

This report demonstrated the superiority of pectoralis major myocutaneous flap (PMMF) than the conservative treatment, local muscle flap, and radiologic or thoracoscopic duct ligation in cirrhotic patient with massive CL.

Keywords

chyle leak, chylous leakage, liver cirrhosis, neck dissection, pectoralis major flap

Author : Chun-Lin Su et al