Chyle Leak

What is a chyle leak?

Chyle leaks are when your lymphatic vessels become damaged, and chyle — a fluid — leaks into nearby tissues, causing swelling and other symptoms. Most chyle leaks occur as rare but serious complications of surgery. Healthcare providers often treat chyle leaks with diet, rest and medication.

Chyle leaks are sometimes known as chylous leaks or chylous fistula.

How common are chyle leaks?

Chyle leaks are rare surgical complications. This condition occurs in less than 1% of thyroidectomies and about 8% of other head and neck surgeries. Chyle leaks can also happen after abdominal surgery, chest surgery or surgery to remove your kidney (nephrectomy).

How serious is a chyle leak?

A chyle leak is serious. These leaks can cause:

• Dehydration.
• Fluid imbalances in your body (changes in electrolyte levels).
• Inability to fight infection (immunosuppression).
• Poor nutrition.

Rarely, chyle leaks can cause:

• Chylothorax: This condition happens when chyle builds up in the pleural space between your lung and chest wall. Healthcare providers may diagnose chylothorax after it presents as pleural effusion.
• Chylous ascites: Chyle builds up in your abdomen. Ascites happens when fluid fills your abdomen.

What causes a chyle leak?

This condition usually happens after traumatic injury to your abdomen, chest or neck. In most cases, the cause of a chyle leak is surgery. Chyle leaks are rare complications of surgery, especially head and neck surgery. They happen because of damage to lymphatic vessels, often in your thoracic duct. Chyle leaks can also be a complication of lymphoma.

What is the thoracic duct?

Your thoracic duct is a large vessel of your lymphatic system, reaching from your abdomen to your neck. Your thoracic duct moves lymph and chyle through your body’s tissues. Lymph from the left side of your body and the lower half of the right side moves through this duct.

What are the symptoms of a chyle leak?

One symptom of a chyle leak is visible chyle during surgery. Healthcare providers also check surgical drains after surgery for increased fluid, especially after you eat foods that contain fat.

After surgery, symptoms of a chyle leak may include:

• Lymphedema.
• Reddening of your skin.
• Swelling above your collarbone (clavicle).

How is a chyle leak diagnosed?

During an operation, surgeons check the area to see if chyle is present before closing the incision. But chyle leaks aren’t always visible. After surgery, healthcare providers check you for signs of a chyle leak.

What tests do healthcare providers use to diagnose a chyle leak?

During surgery, healthcare providers may move your body in certain ways to increase pressure in your chest or abdomen to see if chyle may be leaking. They do this before closing the incision.

As you recover, healthcare providers do a physical examination to check for chyle leak symptoms. They also check any surgical drains for fluids.

If you have swelling, providers may take a sample of the fluid to check the amount of fat (triglycerides) present. High triglycerides in the fluid may mean chyle is leaking.

How is a chyle leak treated during surgery?

If surgeons diagnose a chyle leak during surgery, they may use clips or stitches (sutures) to stop the leak.

How is a chyle leak treated after surgery?

Treatment after surgery depends on how severe the leak is. Your healthcare provider recommends treatment based on your overall health. When chyle leaks don’t respond to dietary changes or medications, providers may recommend surgery to stop the leak.

How do you stop chyle from leaking?

To stop a chyle leak, your healthcare provider may recommend nonsurgical treatments. You may need to:

• Avoid physical activity (bedrest).
• Eat a modified diet.
• Take medications to prevent fat absorption.
• Use stool softeners to stop straining during bowel movements.

What is a chyle leak diet?

Your healthcare provider may tell you to eat a low-fat or fat-free diet for a while. Follow your provider’s instructions to help you stay healthy while the leak heals.

Low-fat diets may include:

• Certain fruits.
• Fat-free breads, cereals and dairy products.
• Lean meats and fish.
• Plain vegetables.

What can’t I eat or drink if I have a chyle leak?

Your healthcare provider may recommend that you avoid foods and drinks that are high in fat and sugar. Some people with a chyle leak need IV fluids to stay hydrated and get nutrition.

What medications do healthcare providers use to treat chyle leaks?

Your provider may prescribe medications to treat chyle leaks. These drugs, which you take through a catheter inserted into a vein (IV), include:

• Somatostatin.
• Octreotide.

Your provider may place medication on the area where the chyle leak is (topical medications) during or after surgery to help close leaks.

How long does it take to recover after chyle leak treatment?

Mild chyle leaks heal after the chyle drains, often in about a week. If a chyle leak doesn’t heal, you may need surgery to repair it.

How can I prevent chyle leaks?

Chyle leaks happen when lymphatic vessels become injured. There isn’t anything you can do to prevent this condition.

What can I expect if I have a chyle leak?

Your healthcare provider will give you detailed instructions about diet and activity. Follow these instructions carefully and keep any follow-up appointments.

How long will I have a chyle leak?

Many chyle leaks heal in about a week with lifestyle and dietary changes.

What other effects are there from a chyle leak?

A chyle leak can make it harder for your body to heal from cuts or wounds. Extra chyle in the tissues near a wound can cause tissues to become inflamed. This inflammation can affect healing and make infection more likely.

What is the outlook if I have a chyle leak?

If the chyle leak heals properly, you’ll return to eating your regular diet. Normal wound healing also resumes once the chyle leak heals. Most chyle leaks heal within a week or so with treatment.

Can you get a chyle leak more than once?

Yes, you can get a chyle leak more than once.

How do I take care of myself if I have a chyle leak?

Follow your healthcare provider’s instructions carefully to give the chyle leak the best chance to heal quickly.

A note from Cleveland Clinic

Chyle leak is a serious condition that sometimes happens when lymphatic vessels become damaged after surgery or injury. Your healthcare provider may recommend eating a special diet and restricting activity to help the leak heal. It’s important to follow instructions to avoid complications like dehydration and malnutrition.