Case 20: Repair of a Thoracic Duct

Abstract

A 72 year old man had undergone an uneventful transhiatal esophagectomy for Barrett’s esophagitis. Ten days later he returns to the hospital with increasing shortness of breath. A large left pleural effusion is diagnosed. A chest tube is placed and creamy fluid was withdrawn. The chest tube continued to drain chyle and he is scheduled for repair of the thoracic duct. To identify the site of the injury to the duct, a 250 mL milk and heavy cream (50:50) mixture is ordered to be given 3 h prior to surgery. This is given, so that the surgeon can observe milky fluid dripping from the open thoracic duct and repair it.