Life threatening presentation of thoracic duct injury post thyroid surgery; a case report
| Autor: | Sarah Jamali, Hamzeh M. Halawani, Sohail Bakkar, Farah Khalifeh, George Saad |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Parathyroidectomy
Chyle leak medicine.medical_specialty Chyle medicine.medical_treatment Thyroid Lobectomy Case Report 030230 surgery Thoracic duct 03 medical and health sciences 0302 clinical medicine Thoracic duct injury medicine 030212 general & internal medicine Completion thyroidectomy Respiratory distress business.industry General surgery Thyroid Thyroidectomy Surgery medicine.anatomical_structure Re-exploration business |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Highlights • Injury to thoracic duct, and the formation of chyle leak, is a rare complication and carries significant metabolic and immunological consequences. • Thoracic duct injury during thyroid surgery is an uncommon event with an incidence rate of 0.5–1.8%. • High output chyle leak in a confined space was life threatening. • Surgeons must be familiar with thoracic duct anatomy. Background Injury to thoracic duct is a rare potential complication of time-honored conventional thyroidectomy. Nevertheless, it can be a cause of significant morbidity, and sometimes life-threatening. Patient findings A 78-year-old female patient with a previous surgical history of thyroid lobectomy for nodular disease presented with primary hyperparathyroidism, and a nodule in the remaining thyroid lobe. The patient underwent completion thyroidectomy and parathyroidectomy. Less than 24 h post operatively, the patient developed progressive shortness of breath and neck swelling requiring immediate intubation and re-exploration. A large amount of chyle was drained and an injured thoracic duct was identified and ligated. Summary In experienced hands thyroid surgery is safe. Nevertheless, factors such as the type of pathology and its extent, the level of surgery, and re-operative surgery increase the risk of postoperative complications. Immediate surgical exploration is necessary when patients present with neck swelling and respiratory distress. In our case, a high output chyle leak in a confined space was life threatening. Conclusion Timely re-exploration following thyroid surgery and thorough knowledge of the anatomy of neck structures is crucial in sparing patients potential morbidity and/or mortality. |
| Databáze: | OpenAIRE |
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