A Case of Chyle Leak after Surgery for Esophageal Cancer in which Lymphangiography Successuflly Identified the Leakage Site

Abstract

The patient was a 68-year-old man who underwent neoadjuvant chemotherapy, followed by thoracoscopic subtotal esophagectomy and gastric tube reconstruction through the posterior mediastinal route for cancer of the lower thoracic esophagus (cStage III). After the operation, he developed large volumes of left pleural effusion and the triglyceride (TG) level in the effusion was high. Accordingly, the condition was diagnosed as left chylothorax. Conservative therapy was started, but it was unsuccessful. Expecting to gain embolism effect as well as diagnose the leakage site we performed a lymphangiography through an inguinal lymph node puncture. On an enhanced image, a portion from where chyle had leaked was confirmed to be around the superior border of pancreas in the upper quadrant of abdomen. Ligation of abdominal lymphatic vessel was performed under laparotomy. After the reoperation, his pleural effusion decreased in volume and was cured. If conservative therapy is unsuccessful and reoperation is considered, we have to bear a possible leak from the abdominal lymphatic vessel in mind and to consider a use of lymphangiography for correct diagnosis and appropriate therapy.