A 59-year-old man underwent right hemilaryngectomy in March 2010 for squamous cell carcinoma of the right vocal cord.
Two years later, functional cervical lymph node metastasis was diagnosed.
During surgery, there is the exit of lymphatic secretion that is repaired by ligation of the lymphatic duct.
After surgery the patient was admitted to the ENT Hospitalization Unit.
Once admitted, 0.05 l of opalescent liquid is detected in the bottle of the redon and the balloon is removed to place the roof drain.
At 48 and 72 hours after the intervention, the drain bag was collected 0.48 and 0.62 l, respectively, despite compression bandage, positioning the patient at 45o and nutritional changes.
One week after the intervention, TPN was started and lymph node drainage was 0.45 l.
During week 2, drainage decreases to 0.23 l.
However, worsening occurs and drainage reaches a maximum of 0.6 l.
Due to the poor evolution of the patient, the Department of Otorhinolaryngology decides to consult the Society of Anesthesiologists when administering somatostatin and/or corticosteroids.
In the scientific literature there are several published cases on the use of somatostatin (or analogues) or epinephrine in patients with cervical lymphorrhagia secondary to a surgical procedure.
In published cases such as that of Co kun et al., the authors placed somatostatin and its analogues in the same therapeutic site; for this reason, the hospital care service proposed its use.
The patient begins treatment with concomitant medication with asbestos orctreotide; 0.4 g amoxicillin/clavulanic acid daily, and 0.0001 g octreotide every 8 hours subcutaneously.
Twenty-four hours after starting treatment, the drainage volume decreased to 0.16 l, but then increased again to 0.39 l the following day.
The drainage volume decreases, so the weave drainage is removed and treatment with opioids is suspended.
The patient continues with TPN, being followed up by the endocrinology service and the nutrition and dietary service.
It also continues with compression bandage, which remains closed.
Given the good evolution of the patient, the scheduled repair surgery is suspended.
Five days after discontinuing neck treatment and removing the roof drainage, inflammation and induration were evident in the neck, but without apparent discomfort.
After observing the patient for 2 days, with lymph losses of approximately 0.1 l per day, the decision was made to restart the treatment with methotrexate, although this time 0.3 g per day.
Treatment with octreotide is maintained, although the frequency of administration is changed to twice daily.
The extracted liquid is maintained at 0.06 l daily for one week.
When verifying that the lymphorrhagia does not remit, the treatment with or without surgery was suspended and a descending pattern for octreotide was prescribed, to end up intervening with the patient in the cervicoctreotide week.
