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Mediastinal metastasectomy from a primary germ cell testicular tumour resulting in occult thoracic duct injury and chylothorax
  1. Umar Ali,
  2. Edward Wang,
  3. Robert Larbalestier
  1. Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
  1. Correspondence to Dr Umar Ali, umar.ali{at}


A 22-year-old man underwent mediastinal metastasectomy for a testicular germ cell tumour via median sternotomy. Intraoperatively, the tumour was massive, measuring 88 mm in anterior-posterior (AP) diameter. It was densely adherent to the trachea and aggressive debulking resulted in tracheal injury. Therefore, the patient was kept nil by mouth for 3 days postoperatively and was discharged uneventfully. He represented only 2 days later with a large right-sided chylothorax. His chylothorax was managed conservatively with insertion of an intercostal catheter (ICC) and a low-fat diet. Over the course of 9 days, the ICC drained approximately 5 L of fluid. His admission was further complicated by severe gastroparesis requiring feeding Nasojejunal (NJ) tube placement. The delayed feeding in this case resulted in late detection of the occult thoracic duct injury. This case illustrates that conservative and multidisciplinary management of a postoperative chylothorax from a suspected thoracic duct injury achieves favourable outcomes avoiding further surgical intervention.

  • urological cancer
  • cardiothoracic surgery
  • stomach and duodenum
  • diet
  • nutritional support
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  • Contributors RL was the consultant surgeon operating on the patient. EW and UA were involved in the postoperative care of the patient. UA was the primary writer for the case report. EW and RL reviewed and finalised the report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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