Diagnosis and treatment of chylous leakage after modified radical mastectomy for breast cancer: a case report

Abstract

The post-operative complication of chylous leakage after breast cancer is relatively rare, and few clinical studies have been published. We report a 64-year-old woman with chylous leakage following modified radical mastectomy. We describe the patient’s diagnostic and treatment process in detail. The patient was diagnosed with grade II (left) breast invasive ductal carcinoma. Post-operatively, the patient's chest wall and axilla were pressurized, and negative pressure drainage was initiated. On the fifth post-operative day, the drainage from the chest wall and axilla increased significantly, and the patient developed chylous leakage on the eighth postoperative day. We injected meglumine diatrizoate (100 mL) and elemene (10 mL) into the patient's axilla, and the chylous leakage gradually resolved 18 days post-operatively. In this report, we focus on managing a case of chylous leakage after modified radical mastectomy for breast cancer. Meglumine diatrizoate combined with elemene is a possible treatment for the management of this rare complication.

A case report of chyle leakage after axillary node clearance in a patient with breast cancer

“…Inject meglumine diatrizoate: If the methods above fail to work, consider injecting meglumine diatrizoate through the drainage tube. [17][18][19] Meglumine diatrizoate's viscous characteristics make it possible to coalesce the leaking lymphatic vessels, by stimulating a traumatic adhesion. 5.…”

“…One case observes drainage coming from the lateral pectoral bundle branch on reoperation, 15 while another case detects along the superolateral of the operative region 16 . Precise compression site plays an important role in efficacy. Inject meglumine diatrizoate: If the methods above fail to work, consider injecting meglumine diatrizoate through the drainage tube 17–19 . Meglumine diatrizoate's viscous characteristics make it possible to coalesce the leaking lymphatic vessels, by stimulating a traumatic adhesion. Adopt Lymphangiography: Lymphangiography can accurately identify leaking points for follow‐up pressure bandaging or surgical suturing 12,16 …”

Chylous Leakage After Breast-Conserving Surgery and Axillary Clearance: Case Report and Management Strategies

“…Negatively pressured drainage and free drainage were described in the literature, and the use of pressure bandaging in conjunction with drainage was also mentioned ( 9 ). Local injection of hypertonic glucose or meglumine diatrizoate was thought to be an effective treatment for refractory chylous leakage, because drugs can cause aseptic inflammation, resulting in lymphatic vessel closure ( 10 , 11 ). Dietary fats are known to increase chyle volume, a low-fat diet may help to reduce flow volumes and allow damaged lymphatic capillaries to repair.…”

Design of Comprehensive System for Screening, Diagnosis, and Treatment of Breast Cancer in Armed Forces

“…Approximately 50% of all breast cancer cases and almost 60% of mortality cases are detected in low-income countries (4,5). In addition, diagnosis, treatment, and survival vary in social groups with different jobs and financial statuses (6,7).…”

“…Although the incidence of breast cancer is low in young women, the importance of early breast examination is such that it becomes a habit (37,38). The main components of breast examination include: (1) position; (2) palpation; (3) pads of fingers are too sensitive for palpation; (4) pressure; (5) perimeter; (6) pattern of search; (7) patient education (36,39).…”