Chylothorax mimicking as anastomotic leak in a case of esoph
Chylothorax, as a complication of surgery for esophageal atresia (EA), is rare. It can be misdiagnosed as reflux of milk into the chest cavity.

Published in the Journal of Clinical Neonatology, the authors present a case of EA complicated by chylothorax. A preterm neonate with anorectal malformation and EA (Gross type C) underwent high sigmoid colostomy and posterolateral thoracotomy. Intraoperatively, the baby was found to have a wide gap between the upper and lower end of the esophagus not amenable to primary repair.

The lower esophageal end was closed using 4-0 vicryl interrupted sutures. The cervical esophagostomy, feeding gastrostomy, and chest tube insertion were done. The chest tube started draining milky fluid 2 days after starting gastrostomy feeds. It was suspected to be lower esophageal stump blow-out with reflux of gastrostomy feeds onto the chest cavity.

Dye study and biochemical analysis of pleural fluid helped to make the correct diagnosis of chylothorax. Successful conservative management of chylothorax was done.

Learning Points:-
- In conclusion, chylothorax can mimic as anastomotic leak or reflux of gastric contents into the chest cavity and should be kept in differential diagnosis after surgery for EA.

- Pleural fluid analysis showing lymphocytic predominant fluid with high fluid/serum triglyceride ratio can clinch the diagnosis.

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