See: Fat absorption
- Conservative management (first-line for most cases)
- Dietary modification
- Start with a medium-chain triglyceride (MCT) diet
- MCTs bypass intestinal lymphatics and enter the portal system directly
- If leak persists or output is high, make patient nil by mouth (NPO) and start total parenteral nutrition (TPN)
- Start with a medium-chain triglyceride (MCT) diet
- Pharmacologic therapy
- Use octreotide (a somatostatin analogue)
- Decreases lymphatic flow and gastrointestinal secretions
- Dose: 100 mcg subcutaneously 3 times daily (can use continuous infusion)
- Use octreotide (a somatostatin analogue)
- Dietary modification
- Interventional radiology
- Consider for persistent or high-output leaks
- Lymphangiography
- Identifies site of leak
- Can be therapeutic via embolization using glue or coils
- Surgical management
- Reserved for refractory cases or ongoing nutritional decline
- Options include:
- Ligation of leaking lymphatics (if localized)
- Repositioning or additional drainage
- Use of sealants like fibrin glue or omental patches
- Additional considerations
- Prevent immunosuppression: chyle loss leads to lymphopenia and hypogammaglobulinemia
- Replace nutrients and volume losses: albumin, fat-soluble vitamins, electrolytes
- Monitor for fluid shifts, edema, and secondary infection
- Prognosis
- Most leaks resolve within 1–2 weeks with conservative management
- Early initiation of dietary and pharmacological therapy improves outcomes