LYMPHOGENOUS CYST-VEIN SHUNT IN THE MANAGEMENT OF CHYLOTHORAX AND CHYLORRHEA

W.B Shen, Y.G Sun, W.D Geng, G.F Wu, Y.X Sun, S Xia

Abstract


A 36 year -old woman developed marked lymphedema and chylous cysts of the lower abdominal wall, groin, labia, accompanied by chylorrhea. After cyst excision and trans­ plantation  of the greater omentum, a left chylothorax occurred . After thoracic duct ligation and left pleurodesis, pleural effusion recurred and worsened. Lymphangioscinti­ graphy and conventional lymphography suggested that undrained enlarged retro­ peritoneal lymphatics in the right iliac fossa had disrupted and lymph had leaked into the left chest from  the right iliac fossa.  Treatment by a lymphatic cyst-vein anastomosis redirected excess chylous lymph into the blood circulation and chylothorax initially remitted. Several years later with recurrence of chylorrhea, the anastomosis was found  to be occluded. After a second operative connection between a lymphogenous cyst and the greater saphenous vein, chylorrhea subsided and chylothorax has remitted for  more than 4 years .



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