Anestis Ninos, Christos Farazi-Chongouki, Ioannis Pougouras, Christos Iordanou, Lampros Palivos, Stephanos Pierrakakis
Department of Surgery, Thriassio General Hospital, Athens, Greece.
Int J Surg Case Rep. 2012;3(7):330-2. doi: 10.1016/j.ijscr.2012.03.021. Epub 2012 Apr 11.
A thoracic duct injury complicated with a chylous fistula is a rather rare occurrence associated with left subclavicular catheterization. We present a new method of its conservative management which seems to be the least interventional described so far. It can be used in cases of this iatrogenic injury irrespective of the rate of chyle loss.
Our case report involves a 59-year-old patient with a high-output chyle fistula due to left subclavicular vein catheterization, in which biological cyanoacrylic glue was used through percutaneous infusion to the venous angle, where the thoracic duct was leaking. An extensive review of the relevant literature is presented.
Most of the high-output fistulas require a long time of conservative treatment, which may result in severe complications due to the prolongation of chyle loss. An operation may be needed in selected cases. Our proposed interventional method can be used in cases of percutaneous injury of a chyle duct, with immediate results.
An iatrogenic chyle fistula due to left subclavicular catheterization can be obtained with a percutaneous injection of biological glue directly onto the injured vessel.
胸导管损伤合并乳糜瘘是一种与左锁骨下置管相关的罕见情况。我们提出一种新的保守治疗方法，这似乎是迄今为止描述的干预最少的方法。无论乳糜丢失率如何，该方法均可用于这种医源性损伤的病例。
我们的病例报告涉及一名59岁因左锁骨下静脉置管导致高流量乳糜瘘的患者，通过经皮向胸导管漏出的静脉角注入生物氰基丙烯酸酯胶水进行治疗。并对相关文献进行了广泛综述。
大多数高流量瘘需要长时间的保守治疗，由于乳糜丢失时间延长可能导致严重并发症。在某些特定情况下可能需要手术。我们提出的介入方法可用于乳糜管经皮损伤的病例，且效果立竿见影。
经皮将生物胶水直接注射到受损血管上可治疗因左锁骨下置管引起的医源性乳糜瘘。
