Recurrent high output chyle fistula post neck dissection resolution with conservative management.

OBJECTIVE

To present a unique case of neck dissection with intraoperative chyle leak and subsequent recurrent high output chyle fistula treated with conservative management.

STUDY

DESIGN

Case report.

METHODS

Literature review of intra-operative chyle leak and post operative chyle fistula management with discussion of a recent representative case within our health system.

RESULTS

We present a case of a 35 year old male who underwent a total laryngectomy and bilateral selective neck dissection for a T4N1 Stage IVA Squamous cell carcinoma of the right supraglottis. Intraoperatively, a chyle leak was identified and surgical measures and fibrin sealant were used to control the leak with a negative fistula test at the completion of the dissection. On post operative day 4, a chyle fistula was identified with a peak output of 2.4 liters over 24 hours. The patient was treated with conservative non-operative measures and the output decreased daily. He was discharged on post operative day 22 with a drainage tube in place, which was removed on post operative day 26. He subsequently developed a recurrence of this fistula on post operative day 37, which was treated conservatively and resolved on post operative day 45.

CONCLUSIONS

High output recurrent chyle fistula may be managed conservatively even if it persists greater than 10 days or output is greater then 2L over 24 hours if the chyle output is responding appropriately and the patient's volume and nutritional status are closely monitored.