A Case of Post-Esophagectomy Chylothorax Successfully Treated with Octreotide after the Failure of Thoracic Duct Ligation in an Esophageal Cancer Patient

Makoto Takagi, Ryosuke Okada, Toshiaki Aoki, Daisuke Matsuda, Yoshihiro Yasuda, Jeong Sik Lee, Yoshiaki Suzuki, Fumiaki Kato, Tetsuo Sumi and Tatsuya Aoki*

Department of Digestive Tract Surgery, Tokyo Medical University Hachiouji Medical Center
Third Department of Surgery, Tokyo Medical University*

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 1,800 ml 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.

Key words
chylothorax, octreotide, esophageal cancer

Reprint requests
Makoto Takagi Department of Digestive Tract Surgery, Tokyo Medical University Hachiouji Medical Center
1163 Tatemachi, Hachiouji, 193-0998 JAPAN

Accepted
July 27, 2005

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