Efficacy of Thoracic Duct Embolization in Managing Severe Refractory Chyle Leak Post-cervical Reconstruction in a Patient With Liver Cirrhosis: A Case Report

TL;DR

A patient with liver cirrhosis and severe chyle leak after neck surgery was successfully treated with thoracic duct embolization when other methods failed.

Contribution

Demonstrates thoracic duct embolization as a safe and effective treatment for refractory chyle leaks in patients with liver cirrhosis.

Findings

Thoracic duct embolization effectively controlled massive chyle leakage in a patient with liver cirrhosis.

Conservative treatments failed, but embolization led to a favorable clinical outcome without complications.

The chyle leak was linked to increased lymph production from portal hypertension due to cirrhosis.

Abstract

This case report describes a patient with a history of liver cirrhosis who underwent neck reconstruction surgery and subsequently experienced substantial chyle leakage, reaching volumes of up to 6,620 mL per day. Conservative interventions such as fasting, a low-fat diet, total parenteral nutrition, drainage management, somatostatin analogs, and factor XIII supplementation proved ineffective, and the patient exhibited a refractory treatment course. The pronounced chyle leakage in this instance was hypothesized to be linked to increased lymph production resulting from portal hypertension associated with liver cirrhosis. Given the resistance to conservative treatment, thoracic duct embolization was performed by the interventional radiology department, effectively controlling the chyle leakage. The patient experienced a favorable clinical trajectory, devoid of complications. These findings indicate that thoracic duct embolization is a safe and efficacious minimally invasive treatment for refractory and massive chyle leakage following neck dissection and may represent a promising alternative before surgical intervention.

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