-Original-

Lymphangiography Was Useful in Postoperative Intractable Chylothorax after Surgery for Esophageal Cancer: A Case Report

Takeshi Shimakawa, Yoshihiko Naritaka, Miki Miyazawa, Shinichi Asaka, Asako Shimazaki, Kentaro Yamaguchi, Hajime Yokomizo, Kazuhiko Yoshimatsu, Shunichi Shiozawa and Takao Katsube

Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan

Postoperative chylothorax after surgery for esophageal cancer is a rare but serious complication. Treatment initially consists of conservative therapy and, if it fails to provide improvement, it is important to perform surgical treatment without delay. We report on a recent case of intractable chylothorax. This report describes a 72-year-old man with Stage III esophageal squamous cell carcinoma. Subtotal esophagectomy, through a right thoracoabdominal approach with two-field lymphadenectomy, and cervical esophagogastric anastomosis via the retrosternal route, were performed. On the 12th postoperative day, a diagnosis of chylothorax was made. Conservative treatment was initiated, but it proved to be ineffective. Therefore, ligation of the thoracic duct via a thoracotomy was performed, but this was not effective, either. Lymphangiography undertaken to identify the site of the leak in the thoracic duct enabled a diagnosis of an extremely rare double thoracic duct and identification of the site of the leak in the thoracic duct, thereby allowing curative direct ligation of the site. This case underscores the remarkable usefulness of lymphangiography in dealing with intractable postoperative chylothorax.

J Nippon Med Sch 2017; 84: 268-273

Keywords
esophageal cancer, chylothorax, lymphangiography

Correspondence to
Dr. Takeshi Shimakawa, Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan
simakasu@dnh.twmu.ac.jp

Received, July 26, 2016
Accepted, December 5, 2016