Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 Nov 26;12(1):347.
doi: 10.1186/s13256-018-1882-x.

Chylothorax after hepatectomy: a case report

Ryusei Yamamoto  1 , Yasuji Mokuno  2 , Hideo Matsubara  2 , Hirokazu Kaneko  2 , Yozo Sato  3 , Shinsuke Iyomasa  2
Affiliations
Case Reports

Chylothorax after hepatectomy: a case report

Ryusei Yamamoto et al. J Med Case Rep. .

Abstract

Background: Chylothorax is the accumulation of chyle within the pleural space. Chylothorax can occur as a complication after multiple different types of surgery, most frequently after thoracic surgery, albeit with an incidence rate of less than 1%. Chylothorax after abdominal surgery is extremely rare, and there are only a few case reports.

Case presentation: A 74-year-old Japanese woman presented with jaundice. She was diagnosed as having hilar cholangiocarcinoma and underwent right hepatectomy, caudate lobectomy, extrahepatic bile duct resection, and lymph node dissection after preoperative percutaneous transhepatic portal vein embolization. Postoperative liver function was normal. She developed chylous ascites on postoperative day 5, for which conservative treatment was initially effective. Dyspnea developed suddenly on postoperative day 42, and she had a massive right pleural effusion and a small amount of ascites. Management with pleural drainage, total parenteral nutrition, and octreotide injections decreased the chylothorax. However, the chylous effusion reaccumulated on postoperative day 57. As conservative treatments ultimately failed, lymphangiography was performed on postoperative day 62. Lymphangiography with Lipiodol (ethiodized oil) revealed extravasation into the pleural space, but the location of the leak was not identified. There was neither obstruction nor dilation of the thoracic duct. A lymphatic leak in her abdominal cavity was not demonstrated. A chest tube was placed after lymphangiography, and the chylothorax was diminished by postoperative day 71. She was discharged on postoperative day 72. Two and a half years after surgery, she is doing well with no evidence of recurrence of either chylothorax or cancer.

Conclusions: Chylothorax can occur after hepatectomy and pleural effusion should raise suspicion for chylothorax. Lymphangiography may be effective for both diagnosis and treatment in the case of chylothorax after hepatectomy.

Keywords: Abdominal surgery; Cholangiocarcinoma; Chylothorax; Hepatectomy; Lymphangiography.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Our institutional ethics committee approved the publication of this case report.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a Endoscopic retrograde cholangiopancreatography showing an intraluminal defect in the biliary hilum, Bismuth type 1. The arrow pointing to the intraluminal defect in the biliary hilum. b Percutaneous transhepatic portal vein embolization showing the embolization of the right branch of the portal vein performed by puncturing the segment 5a portal vein. Embolization was not done percutaneously through the chest
Fig. 2
Fig. 2
Gross specimen showing hilar cholangiocarcinoma
Fig. 3
Fig. 3
Computed tomography showing large pleural effusion on postoperative day 42
Fig. 4
Fig. 4
Computed tomography showing reaccumulation of pleural fluid on postoperative day 57
Fig. 5
Fig. 5
a Post-procedure computed tomography revealing extravasation of Lipiodol (ethiodized oil) adjacent to the right mediodorsal pleural space on the diaphragm, but the location of the leak was not identified. The arrow pointing to the extravasation of Lipiodol (ethiodized oil). b Computed tomography revealing accumulation of Lipiodol (ethiodized oil) near the staple line of the stump of the right hepatic vein. The arrow pointing to the staple line of the stump of the right hepatic vein
Fig. 6
Fig. 6
Post-procedure computed tomography after lymphangiography with Lipiodol (ethiodized oil) showing neither obstruction nor dilation of the thoracic duct. The arrow pointing to the thoracic duct
See this image and copyright information in PMC

References

    1. Doerr CH, Miller DL, Ryu JH. Chylothorax. Semin Respir Crit Care Med. 2001;22:617–626. doi: 10.1055/s-2001-18797. - DOI - PubMed
    1. Doerr CH, Allen MS, Nichols FC, 3rd, Ryu JH. Etiology of chylothorax in 203 patients. Mayo Clin Proc. 2005;80:867–870. doi: 10.4065/80.7.867. - DOI - PubMed
    1. Kurekci E, Kaye R, Koehler M. Chylothorax and chylopericardium: a complication of a central venous catheter. J Pediatr. 1998;132:1064–1066. doi: 10.1016/S0022-3476(98)70414-7. - DOI - PubMed
    1. Ferguson MK, Little AG, Skinner DB. Current concepts in the management of postoperative chylothorax. Ann Thorac Surg. 1985;40:542–545. doi: 10.1016/S0003-4975(10)60345-1. - DOI - PubMed
    1. Terzi A, Furlan G, Magnanelli G, Terrini A, Ivic N. Chylothorax after pleuro-pulmonary surgery: a rare but unavoidable complication. Thorac Cardiovasc Surg. 1994;42:81–84. doi: 10.1055/s-2007-1016462. - DOI - PubMed

Publication types