Abstract
A 61-year-old man was given a diagnosis of esophageal cancer. After preoperative CT revealed azygos continuation of the inferior vena cava with absence of the hepatic segment, we conducted a transthoracic esophagectomy with three-field lymphadenectomy. We recognized the thoracic duct in the normal position and ligated it. On postoperative day 3, we observed a milky-white pleural effusion after starting enteral nutrition. We diagnosed chylothorax. The patient developed severe circulatory and respiratory failure, and required surgery for chylothorax. We performed transthoracic clipping of the damaged lymph vessels after introduction of venovenous extracorporeal membrane oxygenation (ECMO), due to respiratory failure caused by acute respiratory distress syndrome. Chylothorax improved soon after surgery, along with his circulatory and respiratory functions. The ECMO system was removed after 4 days. The patient was weaned off mechanical ventilation on postoperative day 13 and discharged on postoperative day 142. ECMO may be useful for patients with severe respiratory failure who must undergo surgery, despite having vascular dysfunction.
