Fuga quilosa secundaria a linfadenectomía axilar posmastectomía derecha
Palavras-chave:
Fuga Quilosa, Mastectomía, Vaciado Axilar, Quilo, Complicación, Chylous Leak, Mastectomy, Axillary Emptying, Chyle, ComplicationResumo
La fuga quilosa después de la linfadenectomía axilar y la mastectomía es una complicación poco frecuente con incidencia menor a 0,5 %. Paciente femenina de 60 años con diagnóstico de carcinoma ductal infiltrante de mama derecha, recibe tratamiento quirúrgico con mastectomía parcial oncológica más biopsia de ganglio centinela positiva y disección ganglionar axilar. En su tercer día posoperatorio presenta salida de líquido blanco lechoso
a través del dren aspirativo, sugiriendo la posibilidad de fuga quilosa. Las pruebas de laboratorio lo confirman, se explora la zona, localizándose la salida del líquido por un conducto único adyacente a la vena axilar. El traumatismo del conducto torácico puede ser la causa principal de la fuga quilosa, pero se desconoce la causa de dicha lesión durante la cirugía mamaria. La mayoría de los casos pueden ser tratados con medidas conservadoras.
Se presenta un caso de fuga quilosa secundaria a linfadenectomía axilar posmastectomía derecha.
Chylous leakage after axillary lymphadenectomy and mastectomy is a rare complication with an incidence of less than 0.5%. A 60-year-old female patient diagnosed with infiltrating ductal carcinoma of the right breast receives surgical treatment with oncological partial mastectomy plus positive sentinel node biopsy and axillary nodal dissection. On its third postoperative day, it presents a milky white fluid outflow through the aspirative drain, suggesting the possibility of chylous leakage. Laboratory tests confirm this, the area is explored, locating the exit of the fluid through a single duct adjacent to the axillary vein. Trauma to the thoracic duct may be the primary cause of chylous leakage, but the cause of such injury during breast surgery is unknown. Most cases can be treated with conservative measures. We present a case of chylous leakage secondary to axillary lymphadenectomy after right mastectomy.
Downloads
Referências
Wong J, Farkas N, Monib S, Thomson S. A challenging case of a chyle leak following axillary lymph node clearance. J Surg Case Rep. 2020;2020(8):rjaa286. DOI: 10.1093/jscr/rjaa286.
Sarawagi A, Maxwell J. Chyle Leak after right axillary lymph node dissection in a patient with breast cancer. Case Rep Surg. 2021;2021:8812315. DOI: 10.1155/2021/8812315.
Rivas AE. Secuelas del tratamiento preservador del cáncer de mama. Rev Venez Oncol. 2005;17(supl.1):S41-S43.
Melet A. Después de la mastectomía: la calidad de vida. Rev Venez Oncol [Internet]. 2005 [consultado 6 de marzo de 2022];17(2):115-119. Disponible
en: http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S0798-05822005000200010
Al-Ishaq Z, Gupta S, Collins MA, Sircar T. Chyle leak following an axillary sentinel lymph node biopsy for breast cancer in a patient with superior vena caval thrombosis - a case report and review of the literature. Ann R Coll Surg Engl. 2018;100(6):e147-e149. DOI: 10.1308/rcsann.2018.0074.
Sidapra M, Fuller M, Masannat YA. Diagnosis and management of chyle leak following axillary dissection. Surgeon. 2020;18(6):360-364. DOI: 10.1016/j. surge.2019.12.001.
De Felice F, Musio D, Musella A, Tombolini M, Tombolini V. Chyle leak following neck dissection: Could radiotherapy be considered a management option? J Craniofac Surg. 2016;27(2):e115-118. DOI: 10.1097/SCS.0000000000002329.
Bai Y, Tao X, Xu C, Zhu Y. Diagnosis and treatment of chylous leakage after modified radical mastectomy for breast cancer: a case report. J Int Med Res. 2021;49(6):3000605211021375. DOI: 10.1177/03000605211021375.
Ratnayake CBB, Escott ABJ, Phillips ARJ, Windsor JA. The anatomy and physiology of the terminal thoracic duct and ostial valve in health and disease: potential implications for intervention. J Anat. 2018;233(1):1- 14. DOI: 10.1111/joa.12811.
Daggett JD, Watt AW, Smith PD. Chyle leak following right axillary lymph node dissection: A case report and review of current literature. Int J Surg Case Rep.
;20:68-73. DOI: 10.1016/j.ijscr.2015.12.044
di Summa PG, Roos E, Tay SK. Chylous leak: an unexpected complication after microsurgical breast reconstruction. Gland Surg. 2018;7(5):496-498. DOI: 10.21037/gs.2018.08.06.
Kohno N, Kimoto T, Okamoto A, Tanino H. Chyle leakage after axillary node sampling in a patient with breast cancer: a case report. Surg Case Rep. 2020;6(1):119. DOI: 10.1186/s40792-020-00885-y.
Chow WT, Rozen WM, Patel NG, Ramakrishnan VV. Chyle leak after axillary lymph node dissection. J Plast Reconstr Aesthet Surg. 2015;68(5):e105-106. DOI:
1016/j.bjps.2015.01.019. 14. Shibuya Y, Asano K, Hayasaka A, Shima T, Akagi K,
Ozawa N, et al. A novel therapeutic strategy for chylous ascites after gynecological cancer surgery: a continuous low-pressure drainage system. Arch Gynecol Obstet.
;287(5):1005-1008. DOI: 10.1007/s00404-012-2666-y
Al-Ishaq Z, Gupta S, Collins MA, Sircar T. Chyle leak following an axillary sentinel lymph node biopsy for breast cancer in a patient with superior vena caval thrombosis - a case report and review of the literature. Ann R Coll Surg Engl. 2018;100(6):e147-e149. DOI: 10.1308/rcsann.2018.0074.
Singh M, Deo SV, Shukla NK, Pandit A. Chylous fistula after axillary lymph node dissection: incidence, management, and possible cause. Clin Breast Cancer.
;11(5):320-324. DOI: 10.1016/j.clbc.2011.04.003.
González-Sánchez-Migallón E, Aguilar-Jiménez J, García-Marín JA, Aguayo-Albasini JL. Chylous Fistula following Axillary Lymphadenectomy: Benefit of Octreotide Treatment. Case Rep Surg. 2016;2016:6098019. DOI: 10.1155/2016/6098019.
