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

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.