A 32-year-old woman underwent total thyroidectomy in October 2006 and right jugular lymphadenectomy for papillary thyroid carcinoma in the right thyroid lobe, with subsequent ablative dose of I131.
At the end of 2009, right adenopathic tumor without iodine avidity was observed (total body scan after therapeutic doses of I131 negative), so a bilateral functional lymphadenectomy with excision was performed.
During the intervention branches of the thoracic duct were identified, which were ligated with PROLENE® and sealed with TISSUCOL®.
The pathological study confirmed metastatic involvement of lymph nodes of levels II, III and IV right and level VI.
On the 5th postoperative day, the patient presented swelling of the left external third of the surgical wound. A neck computed tomography (CT) showed the presence of a poorly defined supraclavicular vascular collection around the left supraclavicular region.
The suspicion of a lymphatic fistula was established with a low pressure aspiration drainage.
The diagnosis was confirmed by the removal of fluid with a cold appearance with a triglyceride concentration of 840 mg/dl. Drainage output in the first 24 hours was 240 ml.
At that time, the Nutrition Unit was consulted.
1.
We performed a complete nutritional assessment of the patient, with anamnesis, physical examination and analytical determinations.
The patient was normonourished and had no metabolic complications associated with the fistula.
A long-chain low-triglyceride (LCT) diet supplemented with 40 ml/day of medium-chain triglycerides (MCT) was prescribed.
Initially, drainage was maintained at 100-200 ml/day, with the appearance of a feeling that was not present; but later, the output increased to 500-600 ml/day, becoming new catheter.
According to the surgeon responsible for the patient, it was decided to suspend the oral diet, start artificial nutritional support with total nutrition (TPN) and start treatment with somatostatin.
After 16 days with NPT drainage has a seroprevalence rate, so we proceed to reintroduce the oral diet (poor in LCT), suspend TPN and remove drainage without complications
The patient is currently asymptomatic and on a free diet.
