# A rare case report of chylopericardium after esophageal cancer surgery: Diagnostic challenges and successful surgical management

## TL;DR

A rare case of chylopericardium following esophageal cancer surgery is reported, highlighting diagnostic and treatment challenges and successful surgical resolution.

## Contribution

The paper presents a rare clinical case and proposes a successful treatment strategy involving thoracic duct ligation and pericardial fenestration.

## Key findings

- Chylopericardium after esophageal cancer surgery is extremely rare and difficult to diagnose.
- Combining emergency pericardiocentesis with thoracic duct ligation and pericardial fenestration successfully treated the patient.
- Preoperative oral olive oil is recommended to improve thoracic duct identification during surgery.

## Abstract

Chylothorax is a rare but serious complication following thoracic surgery, characterized by the abnormal accumulation of chylous fluid within the pleural cavity or other intrathoracic spaces. Owing to its low incidence, chylothorax is often underrecognized by clinicians. Among its various forms, chylopericardium is even rarer and poses greater clinical challenges.

The patient was a 55-year-old woman who developed acute pericardial tamponade on postoperative day 7, presenting with sudden loss of consciousness and cardiorespiratory arrest. Pericardiocentesis revealed a large volume of chylous fluid. After 19 days in a coma, the patient gradually regained consciousness. On postoperative day 31, she underwent thoracoscopic low thoracic duct ligation and pericardial fenestration. Following the procedure, the volume of drainage decreased significantly, and she was subsequently discharged from the hospital.

Chylopericardium is a rare complication of esophageal cancer. It focuses on the causes of its occurrence and how to accurately diagnose and treat it.

The abnormal occurrence of this case provides key insights into diagnosis, resuscitation, etiology speculation, surgical intervention, and patient rehabilitation, forming a mutually verified comprehensive cycle, which provides important guidance for the management of similar diseases.

•Reported cases of chyloperic effusion and cardiac tamponade after esophageal cancer surgery are extremely rare.•Emergency puncture + low thoracic duct ligation + pericardial opening successfully saved the patient.•Recommended preoperative oral olive oil to improve the rate of thoracic duct recognition

Reported cases of chyloperic effusion and cardiac tamponade after esophageal cancer surgery are extremely rare.

Emergency puncture + low thoracic duct ligation + pericardial opening successfully saved the patient.

Recommended preoperative oral olive oil to improve the rate of thoracic duct recognition