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Case Report
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| A rare presentation of chyle leak following choledochotomy | ||||||
| Emily Calasanz1, Richard Murray2, Mansoor Mehmood3, Rakhshanda Rahman4, Muhammad Nazim5 | ||||||
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1MD, Texas Tech University Health Sciences Center, Department of Surgery, 1400 S Coulter St, Amarillo, TX 79106, USA.
2MD, Consultant Radiologist, Department of Radiology, Northwest Texas Hospital, 1501 S Coulter St, Amarillo, TX 79106, USA. 3MD, Texas Tech University Health Sciences Center, Department of Internal Medicine, 1400 S Coulter St, Amarillo, TX 79106, USA. 4MD, Associate Professor of Surgery, Texas Tech University Health Sciences Center, Department of Surgery, 1400 S Coulter St, Amarillo, TX 79106, USA. 5MD, Assistant Professor of Surgery, Texas Tech University Health Sciences center, Department of Surgery, 1400 S Coulter St, Amarillo, TX 79106, USA. | ||||||
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| How to cite this article |
| Calasanz E, Murray R, Mehmood M, Rahman R, Nazim M. A rare presentation of chyle leak following choledochotomy. Int J Case Rep Images 2015;6(8):498–501. |
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Abstract
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Introduction:
Chyle leak is a known complication of mediastinal and abdominal oncological procedures. Few cases of chyle leak involving biliary tree have been reported following laparoscopic cholecystectomy. We present a rare case of chyle leak following open choledochotomy and T- tube placement.
Case Report: A 29-year old Caucasian female with no significant past surgical or medical history was admitted with a several day history of right upper quadrant pain, nausea, and intolerance to food. Workup revealed a dilated common bile duct with filling defect consistent with choledocholithiasis. Patient underwent open cholecystectomy and choledochotomy for common bile duct exploration and removal of the stone. Post operative course became complicated by repeated episodes of nausea and abdominal pain and finding of a well-defined fluid collection in the pancreaticoduodenal region necessitating repeated image guided drainage of the collection. After the removal of the common bile duct stent and T-tube, patient again returned back within a week with recurrent symptoms. A computed tomography (CT) scan of the abdomen showed presence of two new small collections thought likely to be abscesses away from the previous collections. Drainage of the fluid was found to be milky with high triglyceride levels consistent with chyle leak. Patient was managed conservatively and doing well since then. Conclusion: Chyle leak is a rare postoperative complication that requires early recognition and knowledge of its pathophysiology due to high morbidity from malnutrition and excellent response to conservative management in the era of parenteral nutrition. | |
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Keywords:
Chyle leak, Choledochotomy, Open cholecystectomy, Postoperative complication
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Author Contributions
Emily Calasanz – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published Richard Murray – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published Mansoor Mehmood – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Rakhshanda Rahman – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Muhammad Nazim – Substantial contributions to conception and design, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2015 Emily Calasanz et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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