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Nutritional support in patients with low volume chylous fistula following radical neck dissection

Published online by Cambridge University Press:  29 June 2007

M. Al-Khayat ,
O. S. Kenyon ,
H. V. Fawcett  and
J. Powell-Tuck
M. Al-Khayat*
Affiliation:
The Departments of Otolaryngology, The Royal London Hospital, Whitechapel, London E1 1BB.
O. S. Kenyon
Affiliation:
The Departments of Otolaryngology, The Royal London Hospital, Whitechapel, London E1 1BB.
H. V. Fawcett
Affiliation:
The Departments of and Human Nutrition, The Royal London Hospital, Whitechapel, London E1 1BB.
J. Powell-Tuck
Affiliation:
The Departments of and Human Nutrition, The Royal London Hospital, Whitechapel, London E1 1BB.
*
Mr G. S. Kenyon, M.D., F.R.C.S., E.N.T. Department, Royal London Hospital Trust, Whitechapel, London E1 1BB.
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Abstract

One of the well known complications of radical neck dissection is a chylous fistula, which results from injury to the thoracic duct as it enters the left subclavian vein. Such fistulae may cause considerable increased morbidity to a patient who is already debilitated by malignancy and by the increased catabolic response to surgery. Further surgery may be appropriate for those with a high fistula output but conservative therapy is normally advocated for the remainder. Nutritional and electrolyte support for these patients is essential and poses potential problems in management.

We present three such patients. One was fed parenterally and two enterally and in all cases the fistulae closed spontaneously. We examine the known physiological stimuli to chyle production and conclude that the enteral feedings of these patients with fat or an isomolar enteral feed does not, contrary to current belief, increase chyle flow or delay the healing of these fistulae.

Keywords

ChylefistulaNeck dissectionNutrition
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 105 , Issue 12 , December 1991 , pp. 1052 - 1056
Copyright
Copyright © JLO (1984) Limited 1991

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