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Erschienen in: European Spine Journal 9/2018

05.05.2017 | Grand Rounds

Chyluria and chylothorax after posterior selective fusion for adolescent idiopathic scoliosis

verfasst von: Alexander A. Weening, Bernadette Schurink, Jelle P. Ruurda, Richard van Hillegersberg, Ronald L. A. W. Bleys, Moyo C. Kruyt

Erschienen in: European Spine Journal | Ausgabe 9/2018

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Abstract

https://static-content.springer.com/image/art%3A10.1007%2Fs00586-017-5066-y/MediaObjects/586_2017_5066_Figa_HTML.jpg Purpose

To describe and discuss the diagnostic and treatment complexity of lymphatic system complications after scoliosis surgery.

Methods

Surgery for adolescent idiopathic scoliosis is very commonly performed with posterior pedicle screw instrumentation. Complications of the anteriorly based lymphatic system are, therefore, rare. We present a case with complications related to the lymphatic system, which have not been reported before after this type of surgery.

Results

After standard Th3 to Th12 posterior spinal reduction and fusion of a moderate thoracic curve, chyluria and a chylothorax developed in an adolescent girl. This appeared to be caused by an obstruction of the thoracic duct. Thorax drainage and finally thoracoscopic intervention prevented further pulmonal impairment. The exact cause could not be identified and the persistent lymph drainage problems had to be treated with a medium chain triglyceride diet.

Conclusion

With this report, we aim to create awareness of the lymphatic system in general and the possibility of severe complications, even after a posterior only approach of the vertebral column.
Literatur
1.
Zurück zum Zitat Phang KL, Bowman M, Phillips A, Windsor J (2014) Review of thoracic duct anatomical variations and clinical implications. Clin Anat 27(4):637–644CrossRefPubMed Phang KL, Bowman M, Phillips A, Windsor J (2014) Review of thoracic duct anatomical variations and clinical implications. Clin Anat 27(4):637–644CrossRefPubMed
2.
Zurück zum Zitat Skandalakis J, Skandalakis L, Skandalakis P (2007) Anatomy of the lymphatics. Surg Oncol Clin N Am 16(1):1–16CrossRefPubMed Skandalakis J, Skandalakis L, Skandalakis P (2007) Anatomy of the lymphatics. Surg Oncol Clin N Am 16(1):1–16CrossRefPubMed
3.
Zurück zum Zitat Talwar A, Lee HJ (2008) A contemporary review of chylothorax. Indian J Chest Dis Allied Sci 50:343–351PubMed Talwar A, Lee HJ (2008) A contemporary review of chylothorax. Indian J Chest Dis Allied Sci 50:343–351PubMed
4.
Zurück zum Zitat Dumont AE, Mayer DJ, Mulholland JH, Jenner WE (1964) The suppression of immunologic activity by diversion of thoracic duct lymph. Ann Surg 160(3):373–382CrossRefPubMedPubMedCentral Dumont AE, Mayer DJ, Mulholland JH, Jenner WE (1964) The suppression of immunologic activity by diversion of thoracic duct lymph. Ann Surg 160(3):373–382CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Sharma S, Hemal AK (2009) Chyluria—an overview. Int J Nephrol Urol 1:14–26 Sharma S, Hemal AK (2009) Chyluria—an overview. Int J Nephrol Urol 1:14–26
6.
Zurück zum Zitat Gulati S, Gupta N, Singh NP, Batra S, Garg S, Beniwal P et al (2007) Chyluria with proteinuria or filarial nephropathy? An enigma. Parasitol Int 56(3):251–254CrossRefPubMed Gulati S, Gupta N, Singh NP, Batra S, Garg S, Beniwal P et al (2007) Chyluria with proteinuria or filarial nephropathy? An enigma. Parasitol Int 56(3):251–254CrossRefPubMed
7.
Zurück zum Zitat De Almeida AB, Freedman DO (1999) Epidemiology and immunopathology of bancroftian filariasis. Microbes Infect 1(12):1015–1022CrossRefPubMed De Almeida AB, Freedman DO (1999) Epidemiology and immunopathology of bancroftian filariasis. Microbes Infect 1(12):1015–1022CrossRefPubMed
9.
10.
Zurück zum Zitat Akisada M, Tani S (1968) Filarial chyluria in Japan lymphography, etiology, and treatment in 30 cases! Radiology 90(2):311–317CrossRef Akisada M, Tani S (1968) Filarial chyluria in Japan lymphography, etiology, and treatment in 30 cases! Radiology 90(2):311–317CrossRef
11.
Zurück zum Zitat Panchal VJ, Chen R, Ghahremani GG (2012) Non-tropical chyluria: CT diagnosis. Abdom Imaging 37(3):494–500CrossRefPubMed Panchal VJ, Chen R, Ghahremani GG (2012) Non-tropical chyluria: CT diagnosis. Abdom Imaging 37(3):494–500CrossRefPubMed
12.
Zurück zum Zitat McGrath EE, Blades Z, Anderson PB (2010) Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med 104(1):1–8CrossRefPubMed McGrath EE, Blades Z, Anderson PB (2010) Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med 104(1):1–8CrossRefPubMed
13.
Zurück zum Zitat Lameer C (1966) The development of chylothorax in obstruction of the thoracic duct. Ned Tijdschr Geneeskd 110(34):1493–1495PubMed Lameer C (1966) The development of chylothorax in obstruction of the thoracic duct. Ned Tijdschr Geneeskd 110(34):1493–1495PubMed
15.
Zurück zum Zitat Cheng JT, Mohan S, Nasr SH, D’Agati VD (2006) Chyluria presenting as milky urine and nephrotic-range proteinuria. Kidney Int 70(8):1518–1522CrossRefPubMed Cheng JT, Mohan S, Nasr SH, D’Agati VD (2006) Chyluria presenting as milky urine and nephrotic-range proteinuria. Kidney Int 70(8):1518–1522CrossRefPubMed
17.
Zurück zum Zitat Nair SK, Petko M, Hayward MP (2007) Aetiology and management of chylothorax in adults. Eur J Cardiothorac Surg 32(2):362–369CrossRefPubMed Nair SK, Petko M, Hayward MP (2007) Aetiology and management of chylothorax in adults. Eur J Cardiothorac Surg 32(2):362–369CrossRefPubMed
18.
Zurück zum Zitat Chinnock B (2003) Chylothorax: case report and review of literature. J Emerg Med 24(3):259–262CrossRefPubMed Chinnock B (2003) Chylothorax: case report and review of literature. J Emerg Med 24(3):259–262CrossRefPubMed
19.
Zurück zum Zitat Adler RH, Levinsky L (1978) Persistent chylothorax. Treatment by talc pleurodesis. J Thorac Cardiovasc Surg 76(6):859–864PubMed Adler RH, Levinsky L (1978) Persistent chylothorax. Treatment by talc pleurodesis. J Thorac Cardiovasc Surg 76(6):859–864PubMed
20.
Zurück zum Zitat Rheuban KS, Kron IL, Carpenter MA, Gutgesell HP, Rodgers BM (1992) Pleuroperitoneal shunts for refractory chylothorax after operation for congenital heart disease. Ann Thorac Surg 53(1):85–87CrossRefPubMed Rheuban KS, Kron IL, Carpenter MA, Gutgesell HP, Rodgers BM (1992) Pleuroperitoneal shunts for refractory chylothorax after operation for congenital heart disease. Ann Thorac Surg 53(1):85–87CrossRefPubMed
21.
Zurück zum Zitat Misthos P, Kanakis MA, Lioulias AG (2012) Chylothorax complicating thoracic surgery: conservative or early surgical management? Updates Surg 64(1):5–11CrossRefPubMed Misthos P, Kanakis MA, Lioulias AG (2012) Chylothorax complicating thoracic surgery: conservative or early surgical management? Updates Surg 64(1):5–11CrossRefPubMed
22.
Zurück zum Zitat Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR (2010) Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg 139(3):584–589CrossRefPubMed Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR (2010) Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg 139(3):584–589CrossRefPubMed
24.
Zurück zum Zitat Singh I, Dargan P, Sharma N (2004) Chyluria—a clinical and diagnostic stepladder algorithm with review of literature. Indian J Urol 20(2):79–85 Singh I, Dargan P, Sharma N (2004) Chyluria—a clinical and diagnostic stepladder algorithm with review of literature. Indian J Urol 20(2):79–85
25.
Zurück zum Zitat Linden PA, Swanson SJ (2005) Esophageal resection and replacement. In: Sellke F, del Nido P, Swanson S (eds) Sabiston & spencer surgery of the chest, 7th edn. Elsevier Saunders, Philadelphia, pp 627–651 Linden PA, Swanson SJ (2005) Esophageal resection and replacement. In: Sellke F, del Nido P, Swanson S (eds) Sabiston & spencer surgery of the chest, 7th edn. Elsevier Saunders, Philadelphia, pp 627–651
26.
Zurück zum Zitat Schulman A, Fataar S, Dalrymple R, Tidbury I (1978) The lymphographic anatomy of chylothorax. Br J Radiol 51(606):420–427CrossRefPubMed Schulman A, Fataar S, Dalrymple R, Tidbury I (1978) The lymphographic anatomy of chylothorax. Br J Radiol 51(606):420–427CrossRefPubMed
27.
Zurück zum Zitat Jain RK, Padera TP (2003) Development. Lymphatics make the break 299(5604):209–210 Jain RK, Padera TP (2003) Development. Lymphatics make the break 299(5604):209–210
28.
Zurück zum Zitat Kraus GE, Bucholz RD, Weber TR (1990) Spinal cord arteriovenous malformation with an associated lymphatic anomaly. J Neurosurg 73(5):768–773CrossRefPubMed Kraus GE, Bucholz RD, Weber TR (1990) Spinal cord arteriovenous malformation with an associated lymphatic anomaly. J Neurosurg 73(5):768–773CrossRefPubMed
29.
Zurück zum Zitat Djindjian R, Hurth M, Houdart R (1971) Spinal angiomas, segmentary vascular dysplasia and phacomatosis. Rev Neurol (Paris) 124(2):121–142 Djindjian R, Hurth M, Houdart R (1971) Spinal angiomas, segmentary vascular dysplasia and phacomatosis. Rev Neurol (Paris) 124(2):121–142
30.
Zurück zum Zitat Moore KL (1982) The developing human: clinically oriented embryology. WB Saunders, Philadelphia Moore KL (1982) The developing human: clinically oriented embryology. WB Saunders, Philadelphia
Metadaten
Titel
Chyluria and chylothorax after posterior selective fusion for adolescent idiopathic scoliosis
verfasst von
Alexander A. Weening
Bernadette Schurink
Jelle P. Ruurda
Richard van Hillegersberg
Ronald L. A. W. Bleys
Moyo C. Kruyt
Publikationsdatum
05.05.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
European Spine Journal / Ausgabe 9/2018
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-017-5066-y

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