Treatment Strategy on Chylolymphatic/Lymphatic Reflux



Through the seventeenth century, the whole concept of chyle circulation was finally accepted since the lacteal vessels or chyliferous vessels were found by G. Aselli in 1622. Following the discovery of the direction of chylous flow, from intestine to cisterna chyli and then to thoracic duct into the blood circulation by J. Pecquet in 1651, chyloreflux has been well documented: chylous reflux (1670), chylous ascites (1685), and chylothorax (1689). But modern concept of lymphatic circulation has been established barely half century ago, essential for the vertebrates to maintain normal life together with the chyle lymph [8, 9].


  1. 1.
    Papendieck CM. Lymphatic dysplasias in pediatrics. Int Angiol. 1999;18:6–9.PubMedGoogle Scholar
  2. 2.
    Amore M, Tapia L, Mercado D, Pattarone G. Lymphedema: A general outline of its anatomical base. J Reconstr Microsurg. 2015;32:2–9.Google Scholar
  3. 3.
    Kubik S. Atlas fotográfico en color de anatomía humana con sus aplicaciones clínicas. Torax. Barcelona: Ed. Labor; 1969.Google Scholar
  4. 4.
    Rouviere. H. Anatomie des lymphatiques de l homme. Paris: Masson; 1932.Google Scholar
  5. 5.
    Sahn SA. The pathophysiology of pleural effusion. Annu Rev Med. 1990;41:7–13.CrossRefPubMedGoogle Scholar
  6. 6.
    Yang YS, Ma GC, Shih JC, et al. Experimental treatment of bilateral fetal chylothorax usingintra utero pleurodesis. Ultrasound Obstet Gynecol. 2012;39:56–62.CrossRefPubMedGoogle Scholar
  7. 7.
    Mc Grath EE, Blades Z, Anderson PB. Chylothorax. aetiology, diagnosis and therapeutic options. Respir Med. 2010;104:1–8.CrossRefGoogle Scholar
  8. 8.
    Servelle M. Les chylifères. Paris: Expansion scientifique francaise; 1981.Google Scholar
  9. 9.
    Dieter R, Dieter Jr R, Dieter III R. Venous and lymphatic diseases. New York: Ed. McGraw-Hill; 2011.Google Scholar
  10. 10.
    Soto-Martinez M, Massie J. Chylothorax. diagnosis and management in children. Pediatr Respir Rev. 2009;10:199–207.CrossRefGoogle Scholar
  11. 11.
    Bellini C, Eergaz M, Radicioni M, et al. Congenital fetal and neonatal visceral chylous effusions: neonatal chylothorax and chylous ascites revisited. A multicentric retrospective. Lymphology. 2012;45(31):91–102.PubMedGoogle Scholar
  12. 12.
    Vignes S, Beilanger J. Primary Intestinal Lymphangiectasia(Waldmann’s disease). OrphanetJ Rare Dis. 2008;3:5.CrossRefGoogle Scholar
  13. 13.
    Gorham WL, Stout PH. Massive osteolysis (acute spontaneous absorption of bone, phantom bone disease, disappearing bone disease). Bond Joint Surg. 1955;37A:985–1004.CrossRefGoogle Scholar
  14. 14.
    Papendieck CM. Sindrome de Gorham Stout Haferkamp cpn reflujo de quilo. Rev Argent Cir. 2000;79(1–2):7–10.Google Scholar
  15. 15.
    Chachaj A, Drozdz K, Chabowski H, et al. Chyloperitoneum, chylothorax and lower extremity lymphedema in woman with sporadic lymphangioleiomyomatosis: successfully treated with sirolimus. a case report. Lymphology. 2012;45:53–7.PubMedGoogle Scholar
  16. 16.
    Ergaz Z, Bar-Oz B, Yatsiv I, et al. Congenital chylothorax. Clinical course and prognostic significance. Pediatr Pulmonol. 2009;44:806–11.CrossRefPubMedGoogle Scholar
  17. 17.
    Rosa CM, Campisis C, Boccardo F, et al. Chylopericardium. A case report demonstrating utility of lymphography combined with 3D computed tomography for corrective surgical treatment using VATS. Lymphology. 2014;47:40–4.PubMedGoogle Scholar
  18. 18.
    Bellini C, Boccardo F, Campisis C, et al. Congenital pulmonary lymphangiectasia. OrphanetJ Rare Dis. 1990;30:43.Google Scholar
  19. 19.
    Kreutzer G, Galindez H, Bono H. An operation for the correction of tricuspid atresia. JCardiovasc Surg. 1973;66(3):613–21.Google Scholar
  20. 20.
    Gleysteen JJ, Hussey CV, Heckman MG. The cause of coagulopathy after peritoneovenous shunt for malignant ascites. Arch Surg. 1990;125(4):474–7.CrossRefPubMedGoogle Scholar
  21. 21.
    International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology. 2013;46:1–11.Google Scholar
  22. 22.
    Lee BB, Andrade M, Antignani PL, Boccardo F, Bunke N, Campisi C, et al. Diagnosis and treatment of primary lymphedema. Consensus document of the International Union of Phlebology (IUP) -2013. Int Angiol. 2013;32(6):541–74.PubMedGoogle Scholar
  23. 23.
    Campisi C, Bellini C, Campisi C, et al. Microsurgery for Lymphedema. Clinical research and long-term results. Microsurgery. 2010;30(4):256–60.PubMedGoogle Scholar
  24. 24.
    Olszewski WL. The treatment of lymphedema of the extremities with microsurgical lymphovenous anastomosis. Int Angiol. 1988;7:312–21.PubMedGoogle Scholar
  25. 25.
    Chen E, Itkin M. Thoracic duct embolization for chylous leaks. Semin Intervent Radiol. 2011;28:63–74.CrossRefPubMedPubMedCentralGoogle Scholar

Medical Management

  1. 26.
    Soto-Martinez M, Massie J. Chylothorax: diagnosis and management in children. Paediatr Respir Rev. 2009;10(4):199–207.CrossRefPubMedGoogle Scholar
  2. 27.
    Ferrandiere M, Hazouard E, Guicheteau V, et al. Chylous ascites following radical nephrectomy: efficiency ofoctreotide as treatment of a ruptured thoracic duct. Intensive Care Med. 2000;26(4):484–5.CrossRefPubMedGoogle Scholar
  3. 28.
    Bulbul A, Unsur EK. Octreotide as a treatment of congenital chylothorax. Pediatr Pulmonol. 2010;45(6):628. author reply 9–30PubMedGoogle Scholar
  4. 29.
    Rosing DK, Smith BR, Konyalian V, Putnam B. Penetrating traumatic thoracic duct injury treated successfully with octreotide therapy. J Trauma. 2009;67(1):E20–1.CrossRefPubMedGoogle Scholar

Surgical Management

  1. 30.
    Campisi C, Eretta C, Pertile D, Da Rin E, Campisi C, et al. Microsurgery for treatment of peripheral lymphedema: long-term outcome and future perspective. Microsurgery. 2007;27(4):333–8.CrossRefPubMedGoogle Scholar
  2. 31.
    Wheeler AD, Tobias JD. Tension chylothorax in two pediatric patients. Paediatr Anaesth. 2007;17(5):488–91.CrossRefPubMedGoogle Scholar
  3. 32.
    Marts BC, Naunheim KS, Fiore AC, Pennington DG. Conservative versus surgical management of chylothorax. Am J Surg. 1992;164:532–4.CrossRefPubMedGoogle Scholar
  4. 33.
    Lim ST, Ngan H, Wong KK, Ong GB. Leakage of lymph through scrotal skin. J Urol. 1981;125(6):889–90.CrossRefPubMedGoogle Scholar
  5. 34.
    Sales F, Trepo E, Brondello S, Lemaitre P, Bourgeois P. Chylorrhea after axillary lymph node dissection. Eur J Surg Oncol. 2007;33(8):1042–3.CrossRefPubMedGoogle Scholar
  6. 35.
    Alomari AI, Karian VE, Lord DJ, Padua HM, Burrows PE. Percutaneous sclerotherapy for lymphatic malformations: a retrospective analysis of patient-evaluated improvement. J Vasc Interv Radiol. 2006;17:1639–48.CrossRefPubMedGoogle Scholar
  7. 36.
    Dasgupta R, Adams AD, Elluru R, Wentzel MS, Azizkhan RG. Noninterventional treatment of selected head and neck lymphatic malformations. J Pediatr Surg. 2008;43(5):869–73.CrossRefPubMedGoogle Scholar
  8. 37.
    Kim NR, Lee SK, Suh YL. Primary intestinal lymphangiectasia treated by segmental resections of small bowel. J Pediatr Surg. 2009;44(10):e13–7.CrossRefGoogle Scholar
  9. 38.
    Narushima M, Mihara M, Yamamoto Y, Lida T, Koshima I, et al. The intravascular stenting method for treatment of extremity lymphedema with multiconfiguration lymphaticovenous anastomoses. Plast Reconstr Surg. 2010;125(3):935–43.CrossRefPubMedGoogle Scholar
  10. 39.
    McGrath EE, Blades Z, Anderson PB. Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med. 2010;104(1):1–8.CrossRefPubMedGoogle Scholar


  1. 40.
    Teichgraber UK, Nibbe L, Gebauer B, Wagner HJ. Inadvertent puncture of the thoracic duct during attempted central venous catheter placement. Cardiovasc Intervent Radiol. 2003;26(6):569–71.CrossRefPubMedGoogle Scholar
  2. 41.
    Fishman SJ, Burrows PE, Upton J, Hendren WH. Life-threatening anomalies of the thoracic duct: anatomic delineation dictates management. J Pediatr Surg. 2001;36(8):1269–72.CrossRefPubMedGoogle Scholar
  3. 42.
    Maldonado F, Cartin-Ceba R, Hawkins FJ, Ryu JH. Medical and surgical management of chylothorax and associated outcomes. Am J Med Sci. 2010;339(4):314–8.CrossRefPubMedGoogle Scholar
  4. 43.
    Paul S, Altorki NK, Port JL, Stiles BM, Lee PC. Surgical management of chylothorax. Thorac Cardiovasc Surg. 2009;57(4):226–8.CrossRefPubMedGoogle Scholar
  5. 44.
    Nguyen D. Successful management of postoperative chylothorax with fibrin glue in a premature neonate. Can J Surg. 1994;37(2):158–60. ReviewPubMedGoogle Scholar
  6. 45.
    Barret DS. Pleurectomy for chylothorax associated with intestinal lymphangiectasia. Thorax. 1987;42:557–8.CrossRefGoogle Scholar
  7. 46.
    Podevin G, Levard G, Larroquet M, Gruner M. Pleuroperitoneal shunt in the management chylothorax caused by thoracic lymphatic dysplasia. J Pediatr Surg. 1999;34:1420–2.CrossRefPubMedGoogle Scholar
  8. 47.
    Roehr CC, Jung A, Proquitte H, Blankenstein O, Hammer H, et al. Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review. Intensive Care Med. 2006;32:650–7.CrossRefPubMedGoogle Scholar

Chylous Ascites

  1. 48.
    Kobayashi T, Kishimoto T, Kamata S, Otsuka M, Miyazaki M, et al. Rapamycin, a specific inhibitor of the mammalian target of rapamycin, suppresses lymphangiogenesis and lymphatic metastasis. Cancer Sci. 2007;98(5):726–33.CrossRefPubMedGoogle Scholar
  2. 49.
    Patel N, Lewandowski RJ, Bove M, Nemcek Jr AA, Salem R. Thoracic duct embolization: a new treatment for massive leak after neck dissection. Laryngoscope. 2008;118(4):680–3.CrossRefPubMedGoogle Scholar
  3. 50.
    Repko BM, Scorza LB, Mahraj RP. Recurrent chylothorax after neck surgery: percutaneous thoracic duct embolization as primary treatment. Otolaryngol Head Neck Surg. 2009;141(3):426–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.AngiopediatriaUniversidad del Salvador (USAL)Buenos AiresArgentina
  2. 2.Phlebology and Lymphology Unit, Cardiovascular Surgery DivisionCentral Military HospitalBuenos AiresArgentina
  3. 3.III Chair of AnatomyBuenos Aires UniversityBuenos AiresArgentina

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