EMERGENCY CASEBOOK
Chylothorax
1 Adult Intensive Care Unit, Queen’s Medical Centre, Nottingham,, UK
2 Department of Surgery, Queen’s Medical Centre, Nottingham, UK
Correspondence to:
Correspondence to:
MrA Brooks
Department of Surgery, Floor F West Block, Queen’s Medical Centre, Nottingham NG7 2UH, UK;adam.brooks{at}nuh.nhs.uk
During a high-speed road traffic accident, a 26-year-old man suffered multiple fractures of his thoracic vertebrae and bilateral pneumothoraces. The day after admission and commencement of nasogastric feeding, milky fluid was noted in his right chest drain. Feeding was stopped and a contrast oesophogram and oesophagoscopy were performed, which were normal. The chylothorax quickly resolved and both drains were removed on day 6. Initial treatment of chylothorax aims to decompress the pleural space and minimise chyle production by not feeding the patient via the enteral route. Most authors recommend conservative management for 2 weeks or more unless certain parameters are met: average daily chyle loss of > 1.5 l for a 5-day period, or imminent nutritional complications. In this case, surgical management of the chylothorax and spinal fractures was planned. However, conservative management was successful, highlighting the fact that early aggressive surgical intervention for chyle leaks in blunt trauma is not necessary.
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