Surgical intervention in a complicated persistent chyle leak

INTRODUCTION Chyle leak following cervical surgery has a reported incidence of around 2% annually, and the injury primarily favors a left sided involvement. Our patient presented with a right sided neck persistent chyle leak status post cervical neck dissection and radiation therapy. Infection complicated the patient's clinical course, and he inevitably required a right sided VATS thoracic duct ligation. PRESENTATION OF CASE The patient was a 53-year-old African American male, with a past medical history of T1N0 right tonsil carcinoma status post chemo-radiation in 2016. He was found to have a residual right-sided neck mass, and then underwent a total neck dissection of the mass and the involved lymph node levels. DISCUSSION Our patient presented with a right sided lymphatic injury following a total cervical neck dissection. His presentation was uncharacteristic for that the chyle leak was on the right side of his neck, and that he subsequently developed cellulitis and bacteremia due to a prolonged period to surgical intervention. His refractory response to initial conservative measures could have been affected by his prior radiation treatment. CONCLUSION Chyle leakage is a rare complication of total cervical neck dissection, and should always be considered even with right sided involvement. Conservative management is appropriate in the initial presentation; however, if a patient has a prior history of radiation treatment to the involved site, thoracic duct ligation implemented early may prevent complications such as infection, or a prolonged hospital stay. The following case report has been reported in line with the SCARE criteria.