Any volume of output INCB28060 chemical structure for greater than 14 days would indicate failure of conservative therapy and the need for surgical intervention as well [10]. Conservative treatment of chylothorax begins with prompt drainage via

tube thoracostomy and dietary manipulation. The goal of dietary manipulation is to dramatically decrease lymph production since sixty percent of the dietary fat is absorbed by the lymphatic system, and approximately 1500 to 2000 ml of lymph is produced daily. This can be accomplished by completely bypassing the lymphatic circulation with Total Parenteral Nutrition (TPN), or by strict dietary manipulation based on a very low fat diet. We chose the latter to avoid some of the known infectious complications associated SCH727965 with TPN, especially in this high risk patient with multi-system trauma. With either approach, volume status, electrolyte abnormalities and nutritional parameters of the patient should be followed closely and aggressive replacement of nutritional losses of fat soluble vitamins and proteins should be carried out [10, 14, 15]. A diet strategy to limit chyle production involves avoidance of long chain triglycerides (LCTs).

Medium chain triglycerides (MCTs), however, are absorbed directly into the portal circulation without stimulating lymphatic flow, so inclusion of these MCTs in the diet can help to increase caloric intake for healing [11]. These dietary changes 4��8C as in our case were accomplished by a strict low fat diet supplemented with extra protein powder and MCT oil. Elemental peptide-based enteric formulas with less than 3% LCTs and MCTs added are also ideal supplements, as they have been shown to reduce the MG-132 in vivo quantity and duration of chyle output. Though there is no consensus on the definitive duration of this nutritional management, the literature supports that these dietary measures be continued for approximately two weeks [10–12]. In general, once the chyle leak is resolved, then a regular diet may be resumed. In complicated cases, however, it may be advisable to ensure leak resolution

with a provocative high-fat meal before removing a drainage tube. Finally, there are anecdotal data supporting the use of octreotide to promote decreased lymphatic production. The mechanism is based on the reduction of gastrointestinal secretions and sphlancnic blood flow associated with octreotide, thus decreasing lymphatic production. The drug can be given as a continuous infusion or bolus injections [16, 17] Conclusions Although rare, traumatic chylothorax can be a difficult entity to manage especially in a patient with additional traumatic injuries. This case reflects a successful approach to the management of a traumatic chyle leak, using drainage and strict dietary changes, which precluded the need for surgical intervention. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images.