Published online Aug 6, 2021. doi: 10.12998/wjcc.v9.i22.6522
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
Processing time: 108 Days and 18.9 Hours
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.
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.
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.