Chyle fistula is lymphatic fluid leakage from vessels that accumulates in thoracic/abdominal cavities.
Chyle is a fatty fluid produce in the small intestine from digestion that travels to bloodstream.
Accidental injury to lymphatic vessels during neck or chest surgery that causes surgical trauma.
Chyle fistulas are first observed in the 17th century, and they are linked to lymphatic issues or surgeries.
Chyle fistulas from venous hypertension seen in patients with superior vena cava syndrome/thrombosis.
Patients has comorbidities in form of cancer or past surgeries in the chest, neck, or abdomen.
Fistulas filled with chyle exert pressure to cause symptoms ranging from discomfort to emergencies.
Injury to the thoracic duct during surgery can cause chyle leakage, it is a fluid important for nutrition and immune function.
50% of 4L of lymph from intestinal and hepatic lymphatics drain through cisterna chyli. Cisterna chyli located on right posterolateral edge near T12-L3 vertebral bodies.
Epidemiology
1 to 2% of neck dissections and 0.25-1% of thoracic surgeries may develop this complication.
Chylothorax occurs in 0.5 to 2% of thoracic surgeries is common in esophagectomy/lung resection.
It also occurs due to tumor-related lymphomas, thoracic tumors, or metastatic cancers.
Age does not affect chyle fistula, but older patients may show more surgery complications and fistula development. Some studies suggest slight male predominance in chyle fistula incidence.
Anatomy
Pathophysiology
Lymphatics usually heal alone or redirect through rich interconnected collaterals.
Chyle fistulas form when lack of lymphatic collaterals or extensive lymphatic channel injury occurs.
Variations in chyle flow depend on oral due to abnormal lymphatic vessels. High-fat meals increase chyle flow significantly after consumption.
It presents as constant fluid leakage from a wound, pleural effusion, or chylous ascites accumulation in the abdomen.
Etiology
The causes of chyle fistula are:
Surgical trauma
Tumors
Subclavian vein thrombosis
Lymphatic disease
Malignant invasion of the lymphatics
Infection and Inflammatory Conditions
Genetics
Prognostic Factors
Cervical chyle fistulas after neck surgeries have better prognosis due to smaller thoracic duct and lower output.
Low-output fistulas with better prognosis managed conservatively with diet and drainage.
Chyle fistulas from neck or thoracic surgeries have good outcomes with early treatment.
Fistulas from cancer result in worse outcomes due to disease and possible complications.
Clinical History
Collect details including history of present illness, chief complaint, and medical history to understand clinical history of patient.
Chyle fistula is lymphatic fluid leakage from vessels that accumulates in thoracic/abdominal cavities.
Chyle is a fatty fluid produce in the small intestine from digestion that travels to bloodstream.
Accidental injury to lymphatic vessels during neck or chest surgery that causes surgical trauma.
Chyle fistulas are first observed in the 17th century, and they are linked to lymphatic issues or surgeries.
Chyle fistulas from venous hypertension seen in patients with superior vena cava syndrome/thrombosis.
Patients has comorbidities in form of cancer or past surgeries in the chest, neck, or abdomen.
Fistulas filled with chyle exert pressure to cause symptoms ranging from discomfort to emergencies.
Injury to the thoracic duct during surgery can cause chyle leakage, it is a fluid important for nutrition and immune function.
50% of 4L of lymph from intestinal and hepatic lymphatics drain through cisterna chyli. Cisterna chyli located on right posterolateral edge near T12-L3 vertebral bodies.
1 to 2% of neck dissections and 0.25-1% of thoracic surgeries may develop this complication.
Chylothorax occurs in 0.5 to 2% of thoracic surgeries is common in esophagectomy/lung resection.
It also occurs due to tumor-related lymphomas, thoracic tumors, or metastatic cancers.
Age does not affect chyle fistula, but older patients may show more surgery complications and fistula development. Some studies suggest slight male predominance in chyle fistula incidence.
Lymphatics usually heal alone or redirect through rich interconnected collaterals.
Chyle fistulas form when lack of lymphatic collaterals or extensive lymphatic channel injury occurs.
Variations in chyle flow depend on oral due to abnormal lymphatic vessels. High-fat meals increase chyle flow significantly after consumption.
It presents as constant fluid leakage from a wound, pleural effusion, or chylous ascites accumulation in the abdomen.
The causes of chyle fistula are:
Surgical trauma
Tumors
Subclavian vein thrombosis
Lymphatic disease
Malignant invasion of the lymphatics
Infection and Inflammatory Conditions
Cervical chyle fistulas after neck surgeries have better prognosis due to smaller thoracic duct and lower output.
Low-output fistulas with better prognosis managed conservatively with diet and drainage.
Chyle fistulas from neck or thoracic surgeries have good outcomes with early treatment.
Fistulas from cancer result in worse outcomes due to disease and possible complications.
Collect details including history of present illness, chief complaint, and medical history to understand clinical history of patient.
Chyle fistula is lymphatic fluid leakage from vessels that accumulates in thoracic/abdominal cavities.
Chyle is a fatty fluid produce in the small intestine from digestion that travels to bloodstream.
Accidental injury to lymphatic vessels during neck or chest surgery that causes surgical trauma.
Chyle fistulas are first observed in the 17th century, and they are linked to lymphatic issues or surgeries.
Chyle fistulas from venous hypertension seen in patients with superior vena cava syndrome/thrombosis.
Patients has comorbidities in form of cancer or past surgeries in the chest, neck, or abdomen.
Fistulas filled with chyle exert pressure to cause symptoms ranging from discomfort to emergencies.
Injury to the thoracic duct during surgery can cause chyle leakage, it is a fluid important for nutrition and immune function.
50% of 4L of lymph from intestinal and hepatic lymphatics drain through cisterna chyli. Cisterna chyli located on right posterolateral edge near T12-L3 vertebral bodies.
1 to 2% of neck dissections and 0.25-1% of thoracic surgeries may develop this complication.
Chylothorax occurs in 0.5 to 2% of thoracic surgeries is common in esophagectomy/lung resection.
It also occurs due to tumor-related lymphomas, thoracic tumors, or metastatic cancers.
Age does not affect chyle fistula, but older patients may show more surgery complications and fistula development. Some studies suggest slight male predominance in chyle fistula incidence.
Lymphatics usually heal alone or redirect through rich interconnected collaterals.
Chyle fistulas form when lack of lymphatic collaterals or extensive lymphatic channel injury occurs.
Variations in chyle flow depend on oral due to abnormal lymphatic vessels. High-fat meals increase chyle flow significantly after consumption.
It presents as constant fluid leakage from a wound, pleural effusion, or chylous ascites accumulation in the abdomen.
The causes of chyle fistula are:
Surgical trauma
Tumors
Subclavian vein thrombosis
Lymphatic disease
Malignant invasion of the lymphatics
Infection and Inflammatory Conditions
Cervical chyle fistulas after neck surgeries have better prognosis due to smaller thoracic duct and lower output.
Low-output fistulas with better prognosis managed conservatively with diet and drainage.
Chyle fistulas from neck or thoracic surgeries have good outcomes with early treatment.
Fistulas from cancer result in worse outcomes due to disease and possible complications.
Collect details including history of present illness, chief complaint, and medical history to understand clinical history of patient.
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