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. 2010 Aug 1;2010(6):3.
doi: 10.1093/jscr/2010.6.3.

Refractory chylothorax following a transhepatic gunshot wound to the abdomen requiring unorthodox surgical treatment

Joseph Cestero  1 , Hassan Bukhary  1 , Eddy Carrillo  1 , Hassan Rosenthal  1 , Antonio Pepe  1 , Rafael Sanchez  1 , Seong K Lee  1
Affiliations

Refractory chylothorax following a transhepatic gunshot wound to the abdomen requiring unorthodox surgical treatment

Joseph Cestero et al. J Surg Case Rep. .

Abstract

An 18 year-old-male sustained a gunshot wound to the abdomen which required an uneventful hepatorrhaphy. He later returned with a large right effusion and was diagnosed with a chylothorax. The output was persistent despite conservative measures. Thoracotomy with attempted thoracic duct ligation was unsuccessful at decreasing the output. Re-exploration and ligation of the thoracic duct was required thru an abdominal approach.

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Figures

Figure 1
Figure 1
Liver injury with cavitary defect (A). Repair with Omental packing (B).
Figure 2
Figure 2
eturn CXR with large right effusion.
Figure 3
Figure 3
Computerized tomography of the abdomen demonstrating tiny metallic fragments within liver. Fragment adjacent to aorta suspected of injuring retroperitoneal thoracic duct (arrow).
Figure 4
Figure 4
Chest tube with classic appearance of milky white chyle.
Figure 5
Figure 5
Lymphangiogram mapping through groin (A) with attempted embolization of thoracic duct utilizing fluoroscopy (B).
See this image and copyright information in PMC

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