Minimally invasive triumph: the role of thoracic duct embolization in managing severe post-esophagectomy chylothorax.

Abstract

Chylothorax, a rare and severe complication of esophageal cancer surgery, results from damage to the lymphatic system. We report on a 70-year-old female with esophageal cancer and a history of poorly managed diabetes who developed high-flow chylothorax following esophagectomy. Initial conservative measures, including pleural drainage, lymph production reduction medication, and nutritional support, failed to improve her condition. Subsequent surgical attempts to ligate the thoracic duct were also unsuccessful due to extensive pleural adhesions. This led to a referral for percutaneous thoracic duct embolization (TDE). At another medical facility, the patient underwent lymphangiography, cisterna chyli puncture embolization, and cavity puncture drainage. The TDE successfully embolized the thoracic duct, markedly reducing the leakage of chylous fluid. Subsequent CT scans and follow-up assessments confirmed the patient's recovery with no recurrence of chylothorax. This case illustrates the complexities of managing post-esophagectomy chylothorax and highlights the importance of individualized treatment strategies. It also emphasizes the potential of minimally invasive TDE as an effective alternative for treatment-resistant chylothorax cases.