Chyle fistula is defined as a leakage of lymphatic fluid from the lymphatic vessels, typically accumulating in the thoracic or abdominal cavities but occasionally manifesting as an external fistula. It is a rare but potentially devastating and morbid condition.
First described in the 17th century as complications of trauma, chyle fistulas most commonly occur secondary to lymphatic disease or malignancy or following abdominal, neck, or thoracic operations.
Chyle fistulas also can form as a result of venous hypertension, and they have been described in patients with superior vena cava syndrome or thrombosis of the vena cava.
Patients with chyle fistulas usually give histories of some comorbid conditions such as malignancy or prior operations of the chest, neck, or abdomen. In postoperative patients, symptoms become evident after the start of oral feeding and depend on the site of obstruction.
Chyle fistulas can cause extreme morbidity because of loss of fluids, electrolytes, and other nutrients. In addition, chyle fistulas can result in loss of lymphocytes and immune dysfunction. Finally, chyle fistulas are space-filling and exert pressure on surrounding tissues, creating symptoms that can range from minimal discomfort to life-threatening situations.
Treatment of chyle fistulas is determined by the following (see Treatment):
Etiology of the fistula
Amount of output
Site of the fistula