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Departments of *Anesthesiology, Critical Care Medicine, and Thoracic Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan, miyabe{at}md.tsukuba.ac.jp
To the Editor:
Although surgical treatment of chylothorax is controversial (1–3), current surgical treatment is ligation of the thoracic duct (4). During this procedure, it is important to identify the leakage point. For this purpose, we administered milk into the duodenum after induction of general anesthesia and detected the leakage point successfully.
A 65-yr-old man had a left-sided chylothorax after left upper lobectomy. When ligation of the thoracic duct was planned, the surgeons suggested oral intake of milk before induction of general anesthesia. However, we recommended intraduodenal injection of milk after induction of general anesthesia to avoid regurgitation during induction of anesthesia. After bronchial intubation, an 18F nasogastric tube (Argyle®) was inserted into the duodenum with the aid of radiograph image intensifier. Then 200 mL of whole milk was injected through the tube. Thirty minutes after administration, left thoracotomy was performed and the leakage point was identified by the leakage of chyle. After ligation of the leakage part, the second dose of milk was administered through the tube. No leakage was identified thereafter, and the operation was finished uneventfully. The patient was discharged, recovering from the chylothorax.
Administration of milk into the duodenum after induction of general anesthesia is superior to that into the stomach because the leakage point of chyle is recognized quicker. Although it is reported that administration of milk through the jejunostomy tube is safe and effective (5), placement of tubing into jejunum compared with duodenum is not easy. We highly recommend administration of milk into the duodenum.
References
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