- Email: [email protected]
Early ligation in the treatment of injuries to cervical portion of thoracic duct
Early Ligation to Cervical
in the Treatment of Injuries Portion of Thoracic Duct
GEORGE CRILE, JR., M.D., Diplomate, American Board of Surgery, Cleveland, Ohio LTHOUGH a
great deaI has been written about the management of injuries to the thoracic portion of the thoracic duct, there is little in the Iiterature regarding injuries to its cervica1 portion. If an injury to the cervical portion of the duct is not recognized and if the duct is not Iigated, prolonged drainage of chyIe ensues. Spontaneous healing of the chyIous fistula is sIow and the persistent drainage is a nuisance. This sequence of events may be avoided if the patient is operated upon again and the duct Iigated as soon as the compIication is recognized.
A
CASE
operation aspiration of the fluid showed it to be miIky; a diagnosis of injury to the thoracic duct was made, and the patient was operated upon again. The Ieak in the thoracic duct was pouring out a thin miIky ffuid and was found without d&uIty. The duct was Iigated; the wound heaIed promptIy and the patient went on to an uncompIicated convaIescence. COMMENT
It is IikeIy that many surgeons have reoperated upon and Iigated injured thoracic ducts, but recent surgical Iiterature makes littIe or no mention of this method of treatment for injuries to the cervica1 portion of the duct. Since proIonged disability may attend conservative treatment of a Ieaking duct, it is preferabIe to expIore the neck as soon as the diagnosis of chyIous effusion is made. Feeding the patient a IittIe cream a short time before the operation may make it easier to find the end of the duct.
REPORT
The patient was a young woman who gave a history of having had a thyroid Iobectomy for papiIIary carcinoma of the thyroid. A firm Iymph node 2 cm. in diameter was paIpabIe in the left mid-cervica1 region and a neck dissection was advised. Under genera1 anesthesia a Ieft neck dissection was performed and the fat and Iymph node-bearing tissue was removed from the superior mediastinum. The dissection was easy and no technica compIications were noted during the procedure. The thoracic duct was not seen. Twenty-four hours after operation it was noted that there was an unusua1 amount of serum in the wound. Forty-eight hours after
SUMMARY
The cervica1 portion of the thoracic duct was injured in the course of a neck dissection. Two days after operation the coIIection of chyIe in the wound was recognized. The duct was ligated without deIay and the patient’s convaIescence was uneventful.
673
American
Journal
of Surgery,
Volume
88. October. 19.~4
in the Treatment of Injuries Portion of Thoracic Duct
GEORGE CRILE, JR., M.D., Diplomate, American Board of Surgery, Cleveland, Ohio LTHOUGH a
great deaI has been written about the management of injuries to the thoracic portion of the thoracic duct, there is little in the Iiterature regarding injuries to its cervica1 portion. If an injury to the cervical portion of the duct is not recognized and if the duct is not Iigated, prolonged drainage of chyIe ensues. Spontaneous healing of the chyIous fistula is sIow and the persistent drainage is a nuisance. This sequence of events may be avoided if the patient is operated upon again and the duct Iigated as soon as the compIication is recognized.
A
CASE
operation aspiration of the fluid showed it to be miIky; a diagnosis of injury to the thoracic duct was made, and the patient was operated upon again. The Ieak in the thoracic duct was pouring out a thin miIky ffuid and was found without d&uIty. The duct was Iigated; the wound heaIed promptIy and the patient went on to an uncompIicated convaIescence. COMMENT
It is IikeIy that many surgeons have reoperated upon and Iigated injured thoracic ducts, but recent surgical Iiterature makes littIe or no mention of this method of treatment for injuries to the cervica1 portion of the duct. Since proIonged disability may attend conservative treatment of a Ieaking duct, it is preferabIe to expIore the neck as soon as the diagnosis of chyIous effusion is made. Feeding the patient a IittIe cream a short time before the operation may make it easier to find the end of the duct.
REPORT
The patient was a young woman who gave a history of having had a thyroid Iobectomy for papiIIary carcinoma of the thyroid. A firm Iymph node 2 cm. in diameter was paIpabIe in the left mid-cervica1 region and a neck dissection was advised. Under genera1 anesthesia a Ieft neck dissection was performed and the fat and Iymph node-bearing tissue was removed from the superior mediastinum. The dissection was easy and no technica compIications were noted during the procedure. The thoracic duct was not seen. Twenty-four hours after operation it was noted that there was an unusua1 amount of serum in the wound. Forty-eight hours after
SUMMARY
The cervica1 portion of the thoracic duct was injured in the course of a neck dissection. Two days after operation the coIIection of chyIe in the wound was recognized. The duct was ligated without deIay and the patient’s convaIescence was uneventful.
673
American
Journal
of Surgery,
Volume
88. October. 19.~4