Massive pleural effusion and ascites resulting from esophagectomy with extensive lymphadenectomy for cancer of the abdominal esophagus

Chylothorax is an uncommon but well recognized complication of esophagectom y. We present the case of a 57 year-old man with squamous cell carcinoma of the abdominal esophagus who underwent subtotal esophagectomy by right thor acotomy. Post-operatively, the volume of pleural effusion from the right ch est was increased (1600-2000ml/day). The effusion was straw colored, not ch anging to milky after meals. The characteristics and composition of the ple ural fluid were similar to those of chyle. We therefore treated this patien t using methods for treatment of chylothorax, conservatively, by administra tion of OK-432 and minocycline/hydrochloride into the pleural cavity from t he chest tube with success. We discuss the pathophysiology of this unusual condition and its treatment.