Octreotide (Imagine Pharma)

Chylous fistula or “chyle leak” is a rare complication of head and neck surgery that can be exceedingly difficult to manage. Traditional treatments include pressure dressings, dietary modification, octreotide administration, closed suction drainage, and revision surgery. In 2017, the Otolaryngology team at the University of New Mexico Hospital (UNMH) began implementing negative pressure wound therapy (NPWT) in conjunction with traditional conservative measures to treat chylous fistula. From our initial experiences implementing NPWT, an optimized protocol was developed and is now routinely used to manage chyle leaks at our institution.

A retrospective chart review was performed to identify all patients who were treated with negative pressure wound therapy at UNMH after undergoing neck surgery and developing a chylous fistula. These patients were compared to a control group of patients with chylous fistula who were treated with traditional approaches alone before NPWT was implemented at UNMH.

Twenty-six patients were treated with NPWT for their chyle leak after neck surgery, 10 as part of the original protocol (Protocol 1) and 16 under an improved methodology (Protocol 2). No instances of great vessel desiccation were observed in any patient treated with NPWT. Protocol 2 was found to significantly reduce hospital length of stay as well as to reduce the duration of octreotide administration, dietary modification, and drain device placement compared to the control group treated by historical methods.

NPWT is a novel and effective treatment approach that can be used in addition to traditional treatment modalities to treat chylous fistulae after neck surgery.

Pancreatic pseudocysts are encapsulated, enzyme‐rich peripancreatic fluid collections that typically develop following acute or chronic pancreatitis due to pancreatic ductal disruption. While commonly localized to the lesser sac, rare mediastinal extension may occur, presenting with nonspecific thoracic symptoms such as chest pain, dyspnea, or dysphagia. Cross‐sectional imaging (CT/MRI) is essential for diagnosis. Management is individualized, ranging from conservative medical therapy to endoscopic, percutaneous, or surgical drainage based on symptom severity, complications, and anatomical considerations. We report the case of a 26‐year‐old male with a history of alcohol use and smoking, presenting with cough and dyspnea. Clinical examination revealed tachypnea, hypoxia, and signs of right‐sided pleural effusion. Chest X‐ray revealed complete opacification of the right hemithorax. Diagnostic thoracentesis yielded amylase‐rich pleural fluid (11,545 IU/L). Serum amylase and lipase were also elevated. Contrast‐enhanced CT imaging demonstrated acute necrotizing pancreatitis with peripancreatic collections extending into the thoracic cavity via the esophageal hiatus, confirming a pancreatic pseudocyst with secondary massive right‐sided amylase‐rich pleural effusion. The patient was managed conservatively with antibiotics, octreotide, and ultrasound‐guided pigtail catheter drainage. The clinical course was favorable, with complete symptomatic resolution and no evidence of recurrence on follow‐up. This case underscores a rare but significant thoracic complication of acute pancreatitis manifesting as massive pleural effusion, mimicking thoracic pathology. Thus, accurate diagnosis using contrast‐enhanced CT and MRCP, along with tailored management from conservative therapy to invasive drainage, is crucial. Early recognition and multidisciplinary care ensure favorable outcomes, as highlighted in this case.