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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2012  |  Volume : 23  |  Issue : 2  |  Page : 351-352
The trauma of the thoracic duct is a rare complication of jugular catheterization with fistula lymphatico-cutaneous


Clinique of Dialysis, LILIA Les Plans Zabana, Blida, Algeria

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Date of Web Publication28-Feb-2012
 

How to cite this article:
Djamel Z. The trauma of the thoracic duct is a rare complication of jugular catheterization with fistula lymphatico-cutaneous. Saudi J Kidney Dis Transpl 2012;23:351-2

How to cite this URL:
Djamel Z. The trauma of the thoracic duct is a rare complication of jugular catheterization with fistula lymphatico-cutaneous. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2014 Dec 20];23:351-2. Available from: http://www.sjkdt.org/text.asp?2012/23/2/351/93175
To the Editor,

Lymphatic fistula whether pericardial, pleural and or skin is often secondary to complications after surgery of the neck and thorax, trauma, central venous catheterization, femoral arterial reconstruction, renal transplantation, state cancer syndrome, and superior vena cava stenosis. The cutaneous and lymphatic fistula is a rare complication after jugular catheterization injury of the thoracic duct or by hypertrophy of the thoracic duct. [1],[2],[3],[4]

The thoracic duct is medial close to the esophagus and lymph nodes of the internal jugular vein in front of the internal jugular vein and carotid artery; its flow is 1 L/day with a pressure of 10 cm of water in the canal. There are many variations to its origin: upper thoracic or lower abdominal, reverse channel path, double or multiple channels, and multiple termination crosses. [5]

Conservative management includes a low-fat, parenteral nutrition, repeated aspirations, ele­vation of the head. Whatever therapeutic method used, it must prevent dehydration, coa-gulopathy, peripheral lymphocytopenia, hypo-albuminemia, and infection. A ligature of the thoracic duct is sometimes necessary. [6]

We present our experience of a 59-year-old man with chronic obstructive pulmonary, bronchial dilation, hypertension, arrhythmia and atrial fibrillation developed end-stage renal disease he began dialysis in March 2008 with a catheter through the right jugular track withdrawn later in May 2008 after setting up a radial left arm fistula. Another right jugular catheter was inserted after thrombosis of the fistula in March 2009. There was an overnight appearance of a thick white flow through the orifice of the catheter without any sign of infection. The x-ray of the chest revealed no pleural effusion with normal cardiac volume and the catheter in place. After eight days, the flow persisted and became significantly greenish and the general signs of infection appeared. The catheter was with­drawn, with establishment of an antibiotic treatment. A new catheter was inserted in place over a guide wire. A day after, the flow resumed, and the appearance was typical of a lymph. Unfortunately, no other treatment was practiced.

 
   References Top

1.Muangman P, Scott JR, Muangman S, Benja-thanung R, Suvanchote S. Iatrogenic chylo-thorax in major burn patient: case report and literature review. J Med Assoc Thai 2008;91 (3):417-20.  Back to cited text no. 1
    
2.Varache N, Bouachour G, Le Davay M, Harry P, Alquier P. Bilateral chylothorax following jugular catheterization in woman with com­plete situs inversus. Am J Emerg Med 1991;9 (3):235-6.  Back to cited text no. 2
    
3.Scharff RP, Recto MR, Austin EH 3rd, Wilkerson SA. Fistula lymphocutaneous as a long-term complication of multiple central venous catheter placement. Tex Heart Inst J 2000;27(1):57-60.  Back to cited text no. 3
    
4.Podbielski FJ, Rodriguez HE, Djohan RS Connolly MM, Conlan MD. Spontaneous right cervicothoracic lymphocoele. J Thorac Cardio-vasc Surg 2003;125(3):736-7.  Back to cited text no. 4
    
5.Zawahry MD, El Sayed NM, El-Awady HM, Abdel-Latif A, El-Gindy M. A study of the gross, microscopic and functional anatomy of the thoracic duct and the lympho-venous junction. Int Surg 1983;68(2):135-8.  Back to cited text no. 5
    
6.Complications of central venous catheters Guillaume Jean-congress courses. Ajaccio 2008 SFAV  Back to cited text no. 6
    

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Correspondence Address:
Zouakou Djamel
Clinique of Dialysis, LILIA Les Plans Zabana, Blida
Algeria
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PMID: 22382235

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