Prise en charge du chylothorax postopératoire

Chylothorax is a rare but severe complication of both thoracic and esophageal surgery. The anatomical relationship of thoracic duct and its highly variable anatomy may explain the occurrence of thoracic duct injury during dissection of the posterior mediastinum. At early stage, it can lead to severe cardiorespiratory and volemic complications. In case of chronicization, malnutrition and immunologic complications can occur, responsible for a mortality rate of up to 50%. An optimal management of chylothorax can decrease mortality and is based on three options: conservative treatment, surgery and radiological treatment. Conservative treatment must be initiated since the diagnosis established and allows resolution of chylothorax in 50 to 70% of cases. In case of either high flow chylothorax or failure of conservative treatment, reoperation is indicated. Percutaneous embolization is an interesting and minimally invasive alternative to surgery.