Case Presentation
The patient is a 62-year-old male with a BMI 24.2 who presented with cervical spinal disc disease. He had a herniated nucleus pulposus with associated radiculopathy at the level of C5-C6. He had hypertension, but no other comorbidities at the time of the initial surgery. He underwent anterior cervical disc fusion (ACDF) via a left sided neck approach. There were no complications intraoperatively and no chyle leak was noted. The patient was discharged home following the operation in stable condition. Four months later he presented to clinic with lower left neck pain and swelling inferior to the incision. Exam showed indurated and erythematous left neck and upper chest skin (Figure 1). He had no accompanying symptoms of fever or dysphagia. CT imaging showed a 4x4 cm left lower cervical abscess (Figures 2 and 3). He underwent transcervical incision and drainage. A JP drain was placed at that time. This drain had >1000 cc of cloudy output per day. ENT was consulted. The drainage was felt to be chyle. The patient was taken back to the OR with ENT and thoracic surgery. A fluid cavity with a capsule was noted. The chyloma was felt to have walled itself off. As this capsule was opened, copious chyle was released. The thoracic duct was noted inferior and lateral to the subclavian vein. This was ligated in the chest. Another JP drain was placed. The drain was observed postoperatively, and no further chyle leak was noted. The drain was removed after 5 days. He returned to a regular diet and had no further issues greater than 5 years following the index operation.