A Case of Chylothorax following Resection of Esophageal Carcinoma -Successful Treatment by Pleurodesis with OK-432 and Minocyclin

Hiroyuki Nishi, Masaaki Nakahara, Nobuo Ogino, Kazuyasu Nakao, Chon-Man-Lee, and Masahiko Tsujimato^*

Departments of Surgery and Pathology^*, Osaka Police Hospital

We report a case of chylothorax following resection of esophageal carcinoma which was successfully treated with pleurodesis. A 62-year-old man was admitted to our hospital because of middle intrathoracic esophageal carcinoma. He underwent right thoracolaparotomy, esophagectomy, lymph node dissection, pyloroplasty and intrathoracic anastomosis. On and after the 1st postoperative day, more than 1,400∼2,000 ml/day of drainage continued through a chest tube. On the 10th day, the effusion became milky after oral ingestion of ice-cream. Lymphangiography showed an interruption of the medium flow at the level of Th10. So, we made a diagnosis of chylothorax. Conservative treatment with total parenteral nutrition and supplement of albumin did not decrease the volume of drainage. Therefore, pleurodesis with intrapleural infusion of OK-432 10 KE and minocyclin 200 mg was carried ous for 3 days beginning on the 13th postoperative day. The treatment resulsed in a marked decrease in the drainage, and the chest tube was removed on the 18th day. The pleural effusion was almost resolved by the 55th day, and no symptoms such as dyspnea and chest pain were observed. We reviewed four cases of pleurodesis for chylothorax after resection of esophageal carcinoma. All the cases were treated successfully.

Key words
chylothorax, esophageal cancer, pleurodesis

Reprint requests
Hiroyuki Nishi Departments of Surgery, Osaka Police Hospital 10-31 Kitayamacho, Tennoji-ku, Osaka, 543-8502 JAPAN

Accepted
December 9, 1998

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