Thoracic duct-cutaneous fistula in a patient with cirrhosis of the liver: Successful treatment with a transjugular intrahepatic portosystemic shunt

B. G. Rosser, J. J. Poterucha, M. A. McKusick, Patrick Sequeira Kamath

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Patients with cirrhosis of the liver have increased hepatic and gastrointestinal lymph flow that may contribute to the formation of ascites and pleural effusions. Increased lymph flow, which is due to post-sinusoidal portal hypertension, causes a high rate of flow through the thoracic duct. Because of the high flow rates, disrupted lymphatic vessels in patients with cirrhosis of the liver may fail to close, a situation that results in chylous ascites, pleural effusions, or chylous fistulas. Chylous fistulas deplete proteins, fluid, and lymphocytes and thus lead to volume depletion and coagulopathy. Herein we describe an unusual case in which a high-output traumatic thoracic duct-cutaneous fistula developed in a patient with cirrhosis and led to volume depletion and coagulopathy. Correction of the portal hypertension with placement of a transjugular intrahepatic portosystemic shunt led to closure of the fistula and normalization of accompanying metabolic abnormalities.

Original languageEnglish (US)
Pages (from-to)793-796
Number of pages4
JournalMayo Clinic Proceedings
Volume71
Issue number8
StatePublished - 1996

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Cutaneous Fistula
Transjugular Intrahepatic Portasystemic Shunt
Thoracic Duct
Liver Cirrhosis
Fistula
Portal Hypertension
Lymph
Pleural Effusion
Chylous Ascites
Lymphatic Vessels
Ascites
Fibrosis
Therapeutics
Lymphocytes
Liver
Proteins

ASJC Scopus subject areas

  • Medicine(all)

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Thoracic duct-cutaneous fistula in a patient with cirrhosis of the liver : Successful treatment with a transjugular intrahepatic portosystemic shunt. / Rosser, B. G.; Poterucha, J. J.; McKusick, M. A.; Kamath, Patrick Sequeira.

In: Mayo Clinic Proceedings, Vol. 71, No. 8, 1996, p. 793-796.

Research output: Contribution to journalArticle

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