Huang XM, Luo M, Ran LY, You XH, Wu DW, Huang SS, Gong Q. Chylothorax following posterior low lumbar fusion surgery: A case report. World J Clin Cases 2021; 9(22): 6522-6530 [PMID: 34435021 DOI: 10.12998/wjcc.v9.i22.6522]
Corresponding Author of This Article
Shi-Shu Huang, MD, PhD, Professor, Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. h0794062@scu.edu.cn
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 6, 2021; 9(22): 6522-6530 Published online Aug 6, 2021. doi: 10.12998/wjcc.v9.i22.6522
Chylothorax following posterior low lumbar fusion surgery: A case report
Xian-Ming Huang, Ming Luo, Li-Yu Ran, Xuan-He You, Di-Wei Wu, Shi-Shu Huang, Quan Gong
Xian-Ming Huang, Ming Luo, Li-Yu Ran, Xuan-He You, Di-Wei Wu, Shi-Shu Huang, Quan Gong, Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Huang XM and Gong Q were the patient’s surgeons, reviewed the literature, and contributed to manuscript drafting; Luo M and Ran LY reviewed the literature and contributed to manuscript drafting; You XH and Wu DW consulted the effusion analyses and interpretation and contributed to manuscript drafting; Gong Q analyzed and interpreted the imaging findings; Huang SS and Gong Q were responsible for the revision of the manuscript for important intellectual content; All authors issued final approval for the version to be submitted.
Supported byNational Natural Science Foundation of China, No. 81874027.
Informed consent statement: The participant provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shi-Shu Huang, MD, PhD, Professor, Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. h0794062@scu.edu.cn
Received: April 10, 2021 Peer-review started: April 10, 2021 First decision: May 11, 2021 Revised: May 15, 2021 Accepted: May 25, 2021 Article in press: May 25, 2021 Published online: August 6, 2021
Abstract
BACKGROUND
Postoperative chylothorax is usually regarded as a complication associated with cardiothoracic surgery; however, it is one of the rare complications in orthopedic surgery. This case report describes a female patient who developed chylothorax after a successful L4-S1 transforaminal lumbar interbody fusion surgery. The etiology, diagnosis, and treatment were analyzed and discussed.
CASE SUMMARY
A 50-year-old woman was admitted with repeated back and leg pain. She was diagnosed with L4 degenerative spondylolisthesis, L4/L5 and L5/S1 intervertebral disc herniation and L5 instability, and underwent successful posterior L4-S1 instrumentation and fusion surgery. Unfortunately, thoracic effusion was identified 2 d after operation. The thoracic effusion was finally confirmed to be chylous based on twice positive chyle qualitative tests. The patient was discharged after 12-d persisting drainage, 3-d total parenteral nutrition and fasting, and other supportive treatments. No recurring symptoms were observed within 12 mo follow-up.
CONCLUSION
Differential diagnosis is crucial for unusual thoracic effusion. Comprehensive diagnosis and treatment of chylothorax are necessary. Thorough intraoperative protection to relieve high thoracic pressure caused by the prone position is important.
Core Tip: Differential diagnosis is crucial for idiopathic chylothorax. The diagnosis should be confirmed by laboratory tests and treatment trials. Comprehensive conservative treatments are regarded as the first-line therapy in idiopathic chylothorax patients. To reduce the formation of chyle, fasting and adequate supportive therapy are effective and recommended. Intraoperative protections are necessary to avoid unexpected complications.
