Factors involved in chylothorax following repair of congenital posterolateral diaphragmatic hernia

Mercer, Stanley

doi:10.1016/s0022-3468(86)80374-8

Cited by 19 publications

(25 citation statements)

References 8 publications

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“…Regarding the causes of chylothorax after the repair of CDH, the presence of a sac (seen in 10% of cases of CDH) and the side of the hernia are important factors. Mercer [6] described that all 5 cases of chylothorax after repair of CDH were left-sided, and a sac was present in each case and was excised before repair. Chylothorax is presumably a result of division of the lymphatic vessels within the sac itself [1].…”

Section: Discussionmentioning

confidence: 99%

“…It is likely that lymph vessels related to the diaphragm and to the hernial sac were injured at surgery, rather than the main pathways of chylous drainage of the intestine. The lymph passes from the peritoneal to the pleural space through connecting retroperitoneal lymphatics, and these are mainly present on the left side [6].…”

Section: Discussionmentioning

confidence: 99%

“…Since the major chylous drainage pathways are probably not injured, spontaneous cure is more likely to occur [6]. It is probable that diaphragmatic lymph channels are injured at the hernial repair.…”

Section: Discussionmentioning

confidence: 99%

“…These surgical procedures have been advocated for refractory chylothorax [5]. Where recorded, when the chylous leakage was above the level of 15 ml/kg/d, it was accompanied by high morbidity, which usually necessitated mass ligation of the thoracic duct in children [6]. Others have suggested that 100 ml/k/d should be used as the criterion for surgery [10].…”

Section: Discussionmentioning

confidence: 99%

“…It is important to determine which is the better plan for treatment of chylothorax after repair of CDH: conservative treatment or surgical intervention. In the literature, most cases of chylothorax after repair of CDH did not require surgical interventions [1,2,[4][5][6]. We describe herein a neonate who has treated conservatively for chylothorax after repair of CDH.…”

Section: Introductionmentioning

confidence: 97%

See 4 more Smart Citations

Chylothorax after Repair of Congenital Diaphragmatic Hernia in a Neonate: Usefulness of Conservative Management

Okada¹,

Honda²,

Miyagi³

et al. 2012

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Aim: Chylothorax is a recognized complication after surgery for congenital diaphragmatic hernia (CDH) in a neonate. Management strategies for chylothorax include cessation of enteral feedings, repeated aspiration, chest drainage, and total parenteral nutrition. It is important to determine which is the better plan for treatment of chylothorax after repair of CDH. The authors report successful management by use of the MCT diet for a neonate with chylothorax after repair of CDH. Case: A male infant weighing 3.0 kg was delivered by cesarean section at 38 weeks of gestation and intubated immediately after birth. Prenatal ultrasonography had disclosed left-sided posterolateral diaphragmatic hernia. After stabilization, surgery was performed via a left-sided transverse supra-abdominal incision. The unfixed colon, small bowel, stomach, and spleen were reduced from the chest with little difficulty. A hernia sac was not present and the left-sided posterolateral diaphragm showed a defect 3.5 cm × 2.0 cm in width. The child was fed via a nasogastric tube starting on postoperative day 4 and dyspnea disappeared. Plain chest X-ray on postoperative day 7 showed left pleural radioopacity. A specimen of the chest drainage examined on postoperative day 10 was typical of lymph, with a triglyceride level of 328 mg/dl. The chest drainage was dark yellowish, and a medium-chain triglyceride formula was used until postoperative day 30, by which time the effusion has disappeared. Discussion: Chylothorax after repair of CDH may be a transient disorder that will resolve after a period of diminished flow through the thoracic lymphatics.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

See 3 more Smart Citations

Chylothorax after Repair of Congenital Diaphragmatic Hernia in a Neonate: Usefulness of Conservative Management

Okada¹,

Honda²,

Miyagi³

et al. 2012

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Combined occurrence of chyloperitoneum and chylothorax after surgery and chemotherapy for Wilms' tumor

Jayabose

Kogan

Berezin

et al. 1989

Cancer

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Chyloperitoneum is an extremely rare complication of abdominal surgery in children and a combined occurrence of chylothorax and chyloperitoneum after abdominal surgery has never been reported in children. Chylous ascites usually occurs as a result of operative trauma to the thoracic duct, cisterna chyli, or its tributaries. About one third of all patients with chylous ascites after retroperitoneal lymph node dissection also develop secondary chylothorax. Diaphragmatic defects have been shown to be responsible for the occurrence of chylothorax secondary to chyloperitoneum. Congenital diaphragmatic weakness may result in evagination of the peritoneum causing diaphragmatic blebs, the rupture of which results in the movement of the peritoneal fluid into the pleural cavity. In the authors' patient, the rent in the diaphragm that occurred during surgery was probably responsible for the chylothorax. The role of chemotherapy, if any, in the pathophysiology of this complication is unknown. Total parenteral nutrition (TPN) is a simple and effective treatment for postoperative chylous effusions. Surgical treatments such as abdominal exploration for the repair of leaking lymphatics and peritoneovenous shunt should be reserved for patients who fail TPN.

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A late presenting left‐sided congenital diaphragmatic hernia repair complicated by postoperative chylothorax: A case report

Upadhaya

Joshi

Gyawali

et al. 2020

Clinical Case Reports

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Factors involved in chylothorax following repair of congenital posterolateral diaphragmatic hernia

Cited by 19 publications

References 8 publications

Chylothorax after Repair of Congenital Diaphragmatic Hernia in a Neonate: Usefulness of Conservative Management

Chylothorax after Repair of Congenital Diaphragmatic Hernia in a Neonate: Usefulness of Conservative Management

Combined occurrence of chyloperitoneum and chylothorax after surgery and chemotherapy for Wilms' tumor

A late presenting left‐sided congenital diaphragmatic hernia repair complicated by postoperative chylothorax: A case report

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