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Hartnett DA, Zhang AS, Hogan WB, Daniels AH. Lymphatic Injury with Lymph Fistula After Anterior Lumbar Fusion Managed with Vacuum-Assisted Closure: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00021. [PMID: 34669632 DOI: 10.2106/jbjs.cc.21.00352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 40-year-old man underwent an L5-S1 anterior lumbar interbody fusion (ALIF) and subsequently developed abdominal distention and persistent wound drainage. During wound reexploration, a substantial lymphocele and lymphatic fistula tracking from the ALIF site were visualized and evacuated. The deep space was coated with fibrin sealant. A deep drain and wound vacuum were placed within the retroperitoneal cavity, leading to progressive recovery. CONCLUSION Intraoperative lymphatic injury during anterior spinal surgery can progress to the development of a lymphocele and lymphatic fistula, manageable with an exploratory laparotomy, fibrin sealant, and the use of a wound vacuum to promote fistula sealing.
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Affiliation(s)
- Davis A Hartnett
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
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2
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Joubert C, Monchal T, Junca-Laplace C, Sellier A, Beucler N, Fesselet J, Balandraud P, Dagain A. Management of Chyloretroperitoneum After Lumbar Surgery by Anterior Approach. World Neurosurg 2018; 122:e1211-e1221. [PMID: 30447468 DOI: 10.1016/j.wneu.2018.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Anterior lumbar approach, routinely used in spinal surgery, provides many advantages, specifically avoidance of manipulation and potential injury to nervous system structures; it also provides indirect central and foraminal decompression, with a complication rate of 1%-3%. Chyloretroperitoneum is a rare complication of spinal procedures using anterior lumbar approach. The aim of this study was to discuss diagnosis, treatment, and management of chyloretroperitoneum based on review of the international literature through 2017. METHODS The literature review was conducted using the terms "chyloretroperitoneum," "spinal surgery," and "lymphocele." Additionally, an illustrative case of chyloretroperitoneum following anterior retroperitoneal lumbar approach was presented. RESULTS In 33 cases, including the present case, clinical symptoms appeared after discharge in 75.8% (n = 25) and reflected direct mass effect. Abdominopelvic computed tomography permitted assessment of the fluid collection observed as a hypodense collection around the psoas muscle. In 24 cases, drainage of the chyloretroperitoneum was maintained for a mean duration of 2.9 days. Surgery was performed in 14 patients (42.4%) owing to lymphatic collection. In 5 cases, surgery was performed for direct lymphatic vessel treatment. Laparoscopic marsupialization of the collection and peritoneal fenestration were performed, especially after percutaneous drainage failure. CONCLUSIONS Computed tomography was the most useful imaging modality for diagnosis and assessment of associated complications. If puncture alone is not sufficient and should be avoided, percutaneous computed tomography-guided drainage with sclerosing agent administration appears to be a safe and efficient first-line treatment. Laparoscopic fenestration should be used in cases of complicated or recurrent lymphoceles.
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Affiliation(s)
- Christophe Joubert
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France.
| | - Tristan Monchal
- Department of Oncologic and General Surgery, Sainte Anne Military Hospital, Toulon, France
| | | | - Aurore Sellier
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France
| | - Nathan Beucler
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France
| | - Jacques Fesselet
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France
| | - Paul Balandraud
- Department of Oncologic and General Surgery, Sainte Anne Military Hospital, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France
| | - Arnaud Dagain
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France
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Mora de Sambricio A, Garrido Stratenwerth E. Chylothorax following anterior thoraco-lumbar spine exposure. A case report and review of literature. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Mora de Sambricio A, Garrido Stratenwerth E. Chylothorax following anterior thoraco-lumbar spine exposure. A case report and review of literature. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 59:129-33. [PMID: 24794096 DOI: 10.1016/j.recot.2014.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 03/12/2014] [Accepted: 03/13/2014] [Indexed: 02/07/2023] Open
Abstract
Pleural effusion is a possible complication of the thoraco-abdominal approach to the spine. It is more commonly a reactive effusion, but it also may be caused by hemothorax, empyema or, less commonly, a chylothorax. The case of a chylothorax is reported as a late onset complication of a double anterior and posterior instrumented fusion of the lumbar spine. Its management and clinical outcome, and a review of the literature is presented.
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Affiliation(s)
- A Mora de Sambricio
- National Scottish Spinal Deformity Centre, Royal Hospital for Sick Children, Edinburgh, Reino Unido.
| | - E Garrido Stratenwerth
- National Scottish Spinal Deformity Centre, Royal Hospital for Sick Children, Edinburgh, Reino Unido
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Dixon D, Cassidy J. Treatment of Iatrogenic Chyloretroperitoneum with Octreotide Following Spinal Deformity Correction: A Case Report. JBJS Case Connect 2013; 3:e61. [PMID: 29252217 DOI: 10.2106/jbjs.cc.l.00208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Dan Dixon
- Grand Rapids Medical Education Partners/Michigan State University Department of Orthopedics, 300 Lafayette SE, Suite 3400, Grand Rapids, MI 49503.
| | - Jeffrey Cassidy
- Department of Pediatric Orthopaedics, Helen DeVos Children's Hospital, 1425 Michigan Street NE, Grand Rapids, MI 49503.
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Lin SZ, Tong HF, Qin YS, Ni ZL, Zhang W. Prevention and treatment of lymphorrhoea following surgery for gastric cancer. ANZ J Surg 2010; 80:515-8. [PMID: 20795965 DOI: 10.1111/j.1445-2197.2009.05041.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Lymphorrhoea is a rare complication of abdominal surgery. However, there have been a few reports of lymphorrhoea following radical gastrectomy. Here, we retrospectively review the clinical analysis and treatment of lymphorrhoea based on our experiences. METHODS We retrospectively reviewed a total of 1596 patients who underwent surgery for gastric cancer between January 1995 and January 2007. D1 and D2 lymphadenectomies were performed in 1104 patients, and D3 and D4 lymphadenectomies were performed in the other 492 patients. Disrupted lymph vessels were ligated in 545 patients, and electrically cauterized in 559 patients. Before December 31 2000, total parenteral nutrition (TPN) was administered to all the patients, and after 1 January 2001, TPN was supplemented with octreotide in all the post-operative patients. RESULTS The incidence of lymphorrhoea in patients with D3 and D4 lymphadenectomy was much higher than that in D1 and D2 lymphadenectomy patients (P < 0.05). In addition, the incidence of lymphorrhoea in patients in whom the electrotome cautery was significantly higher than that in patients who received ligation. The addition of octreotide to TPN can reduce the quantity and duration of lymphorrhoea (P < 0.05). CONCLUSION Ligating rather than cauterizing the disrupted lymph vessels can be done to minimize the incidence of lymphorrhoea. The combination of Octreotide and TPN appears to be an effective therapeutic modality for lymphorrhoea.
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Affiliation(s)
- Sheng-Zhang Lin
- Department of General Surgery, First Affiliated Hospital of Zhejiang, University, Hangzhou, China.
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7
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Treatment and prevention of lymphorrhea after radical gastrectomy of gastric cancer. J Cancer Res Clin Oncol 2008; 135:613-6. [PMID: 18846385 DOI: 10.1007/s00432-008-0495-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 09/21/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE Lymphorrhea is an uncommon complication of abdominal surgery. Here, we retrospectively investigate the treatment and prevention of lymphorrhea after radical gastrectomy. METHODS From January 1995 to January 2007, a total of 1,596 patients who underwent surgery for gastric cancer were investigated. According to the AJCC cancer stage manual, tumor stages of 693 (43.4%) cases were T1 or T2 and 903 (56.6%) cases were T3 or T4. A total of 1,104 (69.2%) patients received grade D1 lymphadenectomy or grade D2, and 492 (30.8%) patients received grade D3 or D4. Ligation was used during the lymphadenectomy in 829 (51.9%) patients, and the electrotome cautery was used in 767 (48.1%) patients. Patients diagnosed of lymphorrhea were treated with total parenteral nutrition (TPN) alone before 2001, and with TPN plus octreotide after 2001. RESULTS The incidence of lymphorrhea of patients with D1-2 lymphadenectomy was much lower than those with D3-4 lymphadenectomy (P < 0.01). For patients whose lymphatic vessels were ligated during the operation, the incidence of lymphorrhea was much lower than those lymphatic vessels were electrically cauterized (P < 0.01). No significant difference of incidence of lymphorrhea could be found between patients with T1-2 and T3-4 tumor stages (P > 0.05). Octreotide or TPN administration can reduce the quantity and duration of lymphorrhea,and the combination of Octreotide and TPN has a more significant effect on lymphorrhea than TPN alone (P < 0.01). CONCLUSION The major cause of lymphorrhea following radical gastrectomy was the inappropriate management of lymphadenectomy. Avoiding an extensive lymphadenectomy at surgery and ligating the disrupted lymph vessels would reduce the incidence of lymphorrhea. The combination of Octreotide and TPN is an effective therapeutic modality for lymphorrhea.
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Pee YH, Kim KJ, Choi YG, Jeon SH, Park JD, Lee SH. Lymphocele formation after anterior lumbar interbody fusion at L4-5. Case report. J Neurosurg Spine 2007; 7:566-70. [PMID: 17977202 DOI: 10.3171/spi-07/11/566] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this report, the authors present the case of patient with a lymphocele in the retroperitoneal area following anterior lumbar interbody fusion at L4-5. A lymphocele is a rare complication of spinal operations, especially lower lumbar spinal surgeries. The authors discuss this complicating factor and describe its features and treatments.
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Affiliation(s)
- Yong Hun Pee
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
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Upadhyaya CD, Park P, La Marca F. Chyloretroperitoneum following anterior spinal deformity correction. J Neurosurg Spine 2007; 7:562-5. [DOI: 10.3171/spi-07/11/562] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ Chyloretroperitoneum is an uncommon complication following spinal surgery. The authors present the case of a patient in whom conservative treatment and initial surgical measures failed to relieve varied symptoms of postsurgical chyloretroperitoneum. Following attempts at conservative management, a peritoneal window was surgically created to divert lymphatic flow from the retroperitoneal space into the peritoneal space, where it was resorbed. This unique surgical technique provides yet another option in the treatment of refractory chyloretroperitoneum following anterior lumbar spinal surgery. The authors describe their technique and review retroperitoneal lymphatic anatomy along with similar case reports in the literature.
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Amini A, Apfelbaum RI, Schmidt MH. Chylorrhea: a rare complication of thoracoscopic discectomy of the thoracolumbar junction. J Neurosurg Spine 2007; 6:563-6. [PMID: 17561746 DOI: 10.3171/spi.2007.6.6.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓The thoracic duct along with the cisterna chyli is a major lymphatic pathway near the anterior thoracolumbar spine. Despite the fragile nature of the lymphatic system and its proximity to the spinal column, chylorrhea is rarely encountered by spine surgeons. The authors present a unique case of chylorrhea associated with a left thoracoscopic, trans-diaphragmatic discectomy and fusion for a T12–L1 herniated disc. The anomalous location of the thoracic duct at the left lateral vertebral column contributes to this unusual complication.
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Affiliation(s)
- Amin Amini
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah 84132, USA
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Su IC, Chen CM. Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2007; 16 Suppl 3:332-7. [PMID: 17273839 PMCID: PMC2148082 DOI: 10.1007/s00586-007-0305-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Revised: 10/25/2006] [Accepted: 12/19/2006] [Indexed: 02/07/2023]
Abstract
Cisterna chyli is prone to injury in any retroperitoneal surgery. However, retroperitoneal chylous leakage is a rare complication after anterior spinal surgery. To the best of our knowledge, only ten cases have been reported in the English literature. We present a case of a 49-year-old man who had lumbar metastasis and associated radiculopathy. He had transient retroperitoneal chylous leakage after anterior tumor decompression, interbody bony fusion, and instrumental fixation from L2 to L4. The leakage stopped spontaneously after we temporarily clamped the drain tube. Intraperitoneal ascites accumulation developed thereafter due to nutritional loss and impaired hepatic reserves. We gathered ten reported cases of chylous leak after anterior thoracolumbar or lumbar spinal surgery, and categorized all these cases into two groups, depending on the integrity of diaphragm. Six patients received anterior spinal surgery without diaphragm splitting. Postoperative chylous leak stopped after conservative treatment. Another five cases received diaphragm splitting in the interim of anterior spinal surgery. Chylous leakage stopped spontaneously in four patients. The remaining one had a chylothorax secondary to postop chyloretroperitoneum. It was resolved only after surgical intervention. In view of these cases, all the chylous leakage could be spontaneously closed without complications, except for one who had a secondary chylothorax and required thoracic duct ligation and chemopleurodesis. We conclude that intraoperative diaphragm splitting or incision does not increase the risk of secondary chylothorax if it was closed tightly at the end of the surgery and the chest tube drainage properly done.
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Affiliation(s)
- I-Chang Su
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, No 7. Chung San South Road, 112 Taipei, Taiwan
| | - Chang-Mu Chen
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, No 7. Chung San South Road, 112 Taipei, Taiwan
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Akcali O, Kiray A, Ergur I, Tetik S, Alici E. Thoracic duct variations may complicate the anterior spine procedures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 15:1347-51. [PMID: 16544156 PMCID: PMC2438572 DOI: 10.1007/s00586-006-0082-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Revised: 10/19/2005] [Accepted: 01/30/2006] [Indexed: 10/24/2022]
Abstract
The aim of this study is to localize and document the anatomic features of the thoracic duct and its tributaries with special emphasis on the spinal surgery point of view. The thoracic ducts were dissected from nine formaldehyde-preserved male cadavers. The drainage patterns, diameter of the thoracic duct in upper, middle and lower thoracic segments, localization of main tributaries and morphologic features of cisterna chyli were determined. The thoracic duct was detected in all cadavers. The main tributaries were concentrated at upper thoracic (between third and fifth thoracic vertebrae) and lower thoracic segments (below the level of ninth thoracic vertebra) at the right side. However, the main lymphatic tributaries were drained into the thoracic duct only in the lower thoracic area (below the level of the tenth thoracic vertebra) at the left side. Two major anatomic variations were detected in the thoracic duct. In the first case, there were two different lymphatic drainage systems. In the second case, the thoracic duct was found as bifid at two different levels. In formaldehyde preservation, the dimensions of the soft tissues may change. For that reason, the dimensions were not discussed and they may not be a guide in surgery. Additionally, our study group is quite small. Larger series may be needed to define the anatomic variations. As a conclusion, anatomic variations of the thoracic duct are numerous and must be considered to avoid complications when doing surgery.
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Affiliation(s)
- Omer Akcali
- Orthopaedics and Traumatology, Dokuz Eylul University, Izmir, Turkey.
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von Knoch M, Michiels I, Mueller S, Siahkamary L. Chylous leakage after thoracolumbar fracture may cause paraplegia. Spine (Phila Pa 1976) 2004; 29:E32-4. [PMID: 14722423 DOI: 10.1097/01.brs.0000105982.30754.09] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case report. PURPOSE This case demonstrates that paraplegia can develop due to chylous leakage into the spinal canal without obvious retroperitoneal or intrathoracic involvement. BACKGROUND INFORMATION This clinical presentation of chylous leakage has not been reported previously. RESULTS A 61-year-old female with osteoporosis suffered a pathologic fracture of the vertebral bodies T12 and L1 and developed partial paraplegia two weeks later. Imaging showed expansive pooling of intraspinal fluid without intrathoracic or retroperitoneal involvement. A blood-tinged fluid was aspirated from dorsal. Repeated surgery by a posterior approach with drainage of the fluid did not improve the patient's condition, so she was finally transferred to our hospital. Under the suspected diagnosis of lymphatic leakage a scintiscan with 123I-iodinephenylpentadekanacid-marked cream verified the presumption of a lymph fistula at the level of T12/L1, originating from the thoracic duct. By permanent draining of the posterior fistula without suction and strict intravenous alimentation the fluid production decreased continuously and finally ceased completely. Simultaneously, the neurologic state improved gradually without returning to normal completely. CONCLUSIONS This case demonstrates that paraplegia can develop due to chylous leakage into the spinal canal without obvious retroperitoneal or intrathoracic involvement. This differential diagnosis should be kept in mind when treating patients with abundant fluid drainage into or from the spinal canal.
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Affiliation(s)
- Marius von Knoch
- Departmentsof Orthopaedics, University of Essen, Essen, Germany.
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Yen CF, Wang CJ, Lin SL, Lee CL, Soong YK. Postlaparoscopic vulvar edema, a rare complication. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2003; 10:123-6. [PMID: 12555007 DOI: 10.1016/s1074-3804(05)60247-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Two cases of unilateral labial edema occurred after laparoscopic presacral neurectomy and were associated with massive chylous ascites. One woman was cured by a second laparoscopy to repair the chylous leakage. In the other, vulvar edema subsided in 2 days and chyloperitoneum subsided spontaneously in 3 weeks. The mechanism of postlaparoscopic vulvar edema is believed to be similar to that of Conn's postparacentesis labial edema, in which the unhealed puncture tract permits ascites to travel through and accumulate in the labia majora.
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Affiliation(s)
- Chih-Feng Yen
- Department of Obstetrics and Gynecology, Division of Gynecologic Endoscopic Surgery, Chang Gung Memorial Hospital, #5, Fu-Hsing Street. Kwei-Shan, Tao-Yuan, 333, Taiwan
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Abstract
PURPOSE Postoperative chylous ascites is a rare complication of retroperitoneal and mediastinal surgery that represents a difficult management problem due to the serious mechanical, nutritional and immunological consequences of the constant loss of protein and lymphocytes. We reviewed the topic of postoperative chylous ascites with special emphasis on the relevant diagnostic and imaging modalities. We propose a novel management algorithm. MATERIALS AND METHODS We performed a MEDLINE search of the literature on chylous ascites using chyloperitoneum as the subject heading and chylous ascites as an additional key word. The search yielded 651 articles. We focused on 102 series, collective reviews and mainly case reports related to the issue of postoperative chylous ascites. RESULTS We propose a novel algorithm based on a step-up approach aimed at promoting decreased lymph production and flow as well as maintaining nutritional balance. The management algorithm integrates repeat palliative paracentesis, dietary measures, total parenteral nutrition therapy, peritoneovenous shunting and surgical closure of the lymphoperitoneal fistula. Due to the remarkable effectiveness of somatostatin therapy for the closure of lymphatic fistula somatostatin therapy should be attempted with or without total parenteral nutrition early in the course of treatment of chylous ascites before any invasive steps are taken. CONCLUSIONS Various management modalities may be used successfully to treat chylous ascites. Therefore, treatment should be individualized and adjusted to the severity of lymphatic leakage and its consequences. The outcome mostly depends on the underlying pathological condition. Thus, in the absence of malignant or congenital underlying pathology the prognosis in cases of postoperative chylous ascites is good with the majority responding to conservative measures.
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Affiliation(s)
- Ilan Leibovitch
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lazennec JY, Pouzet B, Ramare S, Mora N, Hansen S, Trabelsi R, Guérin-Surville H, Saillant G. Anatomic basis of minimal anterior extraperitoneal approach to the lumbar spine. Surg Radiol Anat 1999; 21:7-15. [PMID: 10370987 DOI: 10.1007/bf01635046] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Anterior lumbar spine approaches may be indicated for fusion in degenerative lumbar spine disorders or to fill discal and bone gaps after fracture reduction. We present an anterior extraperitoneal approach applicable to any discal and vertebral levels from T12 to S1. The anatomic study, based on 25 cadavers, highlights retroperitoneal dissection principles for easy kidney and duodenopancreatic mobilisation and direct left anterior access to the entire lumbar spine. We established a precise description of the lumbar veins and the anastomoses between the left renal vein and hemiazygos system, in order to define different topographic and anatomic factors related to safe and easily reproducible approaches for cage or graft implementation. Independent of the level and previous intraperitoneal surgery, lumbar spine access with this approach safeguards the kidney, ureter, spleen, hypogastric plexus and duodenopancreatic system. Regarding operating time, blood-loss and possibilities for freshening and grafting, this technique seems an effective counterbalance to the difficulties and complex technology of endoscopic approaches. The clinical study includes our first 42 cases in traumatic and degenerative lesions. Avoiding the neurologic or hemorrhagic risk inherent in classical posterior lumbar interbody fusion (PLIF) techniques, it can be considered as a reasonable and valid alternative. This technique could be used in the near future for mini invasive discal prosthesis insertion.
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Affiliation(s)
- J Y Lazennec
- Orthopaedic Department, Hôpital Pitié-Salpêtrière, Paris, France
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Abstract
STUDY DESIGN A case report of lymphatic drainage after anterior retroperitoneal debridement and reconstruction for lumbar osteomyelitis. OBJECTIVES To report a case of protracted lymphatic drainage after anterior lumbar surgery, a complication that has not been reported previously. SUMMARY OF BACKGROUND DATA Lymphatic drainage after transthoracic surgery is a well-recognized complication. The possibility of lymphatic drainage after anterior lumbar surgery is less likely to be considered. METHODS The cause, clinical symptoms and appearance, treatment, and differential diagnosis are reviewed. RESULTS Lymphangiography is useful in diagnosis and should be performed early if the diagnosis is in doubt. Percutaneous drainage can facilitate early wound healing. CONCLUSION Lymphatic drainage should be considered in the differential diagnosis of postoperative wound drainage, particularly after surgical debridement for osteomyelitis.
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Affiliation(s)
- D Hanson
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas, USA
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Hart AK, Greinwald JH, Shaffrey CI, Postma GN. Thoracic duct injury during anterior cervical discectomy: a rare complication. Case report. J Neurosurg 1998; 88:151-4. [PMID: 9420091 DOI: 10.3171/jns.1998.88.1.0151] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Chylous fistula resulting from intraoperative injury to the cervical thoracic duct is well described as a complication of neck dissection. However, injury to the thoracic duct during spinal surgery is rarely reported. The authors present the first case of thoracic duct injury occurring during cervical discectomy and fusion via an anterior approach. The anomalous location of the terminal arch of the thoracic duct in this patient contributed to the complication. The morbidity of chyle leakage is minimized by its early recognition, a thorough understanding of lymphatic system anatomy, and aggressive management of the thoracic duct injury.
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Affiliation(s)
- A K Hart
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center, Portsmouth, Virginia 23708-2197, USA
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Nagai H, Shimizu K, Shikata J, Iida H, Matsushita M, Ido K, Nakamura T. Chylous leakage after circumferential thoracolumbar fusion for correction of kyphosis resulting from fracture. Report of three cases. Spine (Phila Pa 1976) 1997; 22:2766-9. [PMID: 9431612 DOI: 10.1097/00007632-199712010-00013] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN A description of the clinical picture of chylous leakage after spinal surgery. OBJECTIVES To present the clinical course of three cases of chylous leakage after spinal surgery and to discuss the pathogenesis of the disease. SUMMARY OF BACKGROUND DATA Chylous leakage is a rare complication after spinal surgery. It has been attributed to direct injury of a lymphatic trunk or one of its major tributaries by surgical maneuver. METHODS Three cases of chylous leakage after circumferential thoracolumbar fusion for correction of kyphosis resulting from fracture were reported. RESULTS All of the three cases were managed successfully; two cases of chyloretroperitoneum detected within 4 days after surgery were healed conservatively, but one case of chylothorax of which the onset was noticed 5 weeks after spinal surgery, required surgical ligation of the thoracic duct and pleurodesis. CONCLUSION Early detection of this disease is important for a good prognosis. Retroperitoneal drainage is necessary for the detection and management of chyloretroperitoneum. The pathogenesis and management of the chylous leakage are discussed in this report.
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Affiliation(s)
- H Nagai
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University, Japan
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Bhat AL, Lowery GL. Chylous injury following anterior spinal surgery: case reports. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 1997; 6:270-2. [PMID: 9294752 PMCID: PMC3454645 DOI: 10.1007/bf01322450] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Chylous leakage is an unusual complication following anterior spinal surgery. This leakage can occur as a result of traumatic injury to the thoracic duct, the cisterna chyli, or the retroperitoneal lymphatic vessels. The authors present case reports of three patients who underwent anterior spinal surgical procedures inadvertently complicated by an injury to the lymphatic system. All patients were managed nonoperatively with tube drainage and hyperalimentation and had uneventful recoveries.
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Affiliation(s)
- A L Bhat
- Research Institute International, Gainesville, FL 32605, USA.
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Rossetti SR, Randone D, Aveta P, Biamino G, Terrone C. Ascite Chilosa Post-Nefrectomia Radicale. Urologia 1991. [DOI: 10.1177/039156039105800513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- S. Rocca Rossetti
- (Clinica Urologica dell'Università di Torino - Direttore: prof. S. Rocca Rossetti)
| | - D.F. Randone
- (Clinica Urologica dell'Università di Torino - Direttore: prof. S. Rocca Rossetti)
| | - P. Aveta
- (Clinica Urologica dell'Università di Torino - Direttore: prof. S. Rocca Rossetti)
| | - G. Biamino
- (Clinica Urologica dell'Università di Torino - Direttore: prof. S. Rocca Rossetti)
| | - C. Terrone
- (Clinica Urologica dell'Università di Torino - Direttore: prof. S. Rocca Rossetti)
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