Chyle Leak

Chyle leaks happen when lymphatic vessels become damaged, and chyle — a fluid inside — leaks into nearby tissues. Most chyle leaks are rare complications of surgery. These leaks happen in about 8% of surgeries on your head and neck, chest or abdomen.

A chyle leak can be serious. The fluid can build up in tissues where it doesn’t belong. A leak also prevents your body from getting substances it needs. Chyle contains key nutrients (like fats and proteins), fluids and white blood cells that fight infections. Related, a leak can lead to poor nutrition, dehydration and infections. In extreme cases, it can be life-threatening.

Your care team will take great care to prevent complications like these. But if a chyle leak happens, they’ll treat it right away to keep you safe. Usually, they can manage it with medicine and changes to your diet until the damaged vessel heals.

Symptoms of a chyle leak

Sometimes, surgeons notice a visible chyle leak during surgery. More often, leaks show up while you’re in the hospital recovering. Your care team will check your surgical drains for increased milky white fluid (chyle), especially after you eat foods that contain fat.

Other symptoms include:

• Neck swelling
• Reddening of your skin near the surgery site
• Shifting fluid beneath the skin above your collarbone when a healthcare provider presses on the area (a sign of fluid buildup in the place where a key lymph vessel — your thoracic duct — drains)

Chyle leak causes

This condition usually happens after injury to your thoracic duct. This large lymphatic vessel reaches from your abdomen to your neck. It moves chyle through your body’s tissues. If it’s damaged, the chyle can leak out into tissues inside your body. It can show up in surgical drains.

Usually, this condition happens after head and neck surgery. But it can happen after surgery on your abdomen or chest, too.

Less often, leaks happen due to injuries or accidents unrelated to surgery. A chyle leak can also be a complication of lymphoma.

Complications of this condition

A chyle leak can be serious without swift treatment. These leaks can cause:

• Changes in electrolyte levels
• Dehydration
• Inability to fight infection
• Poor nutrition
• Slow wound healing

Rarely, they lead to fluid buildup that places pressure on organs. Related conditions include:

• Chylothorax: This condition happens when chyle builds up in the space between your lung and chest wall.
• Chylous ascites: This happens when chyle builds up in your abdomen.

How doctors diagnose this condition

During an operation, surgeons check the area for leaks. They 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.

But the leaks aren’t always visible. As you recover, your care team will watch for signs and symptoms. They’ll check your surgical drains for fluid that’s milky or creamy white, like chyle.

If you have swelling, a provider 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?

If your healthcare provider diagnoses a chyle leak during surgery, they may use clips or stitches (sutures) to stop it.

Treatment after surgery depends on how severe the leak is. You may need to:

• Avoid physical activity
• Eat a modified diet
• Get nutrition through a feeding tube or an IV (parenteral nutrition)
• Take medicines to prevent fat absorption
• Use stool softeners to keep you from straining during bowel movements (constipation can cause pressure that worsens the leak)

When dietary changes or medicine aren’t helping enough, providers may recommend surgery to stop the leak.

What is a chyle leak diet?

Your healthcare provider may tell you to eat a low-fat or fat-free diet for a while. This is because eating fats increases chyle production. More chyle flow may make it harder for the damaged lymph vessel to heal.

Low-fat diets may include:

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

You may need fluids to replenish your electrolytes. You may receive vitamin and mineral supplements to replace those nutrients you’re not getting from chyle. For instance, medium-chain triglyceride (MCT) supplements are an important part of a chyle diet. They provide your body with healthy fats without increasing chyle flow.

What medications do healthcare providers use to treat this condition?

Your provider may prescribe medications that change the way your body absorbs nutrients. This reduces strain on your lymph vessels while you’re healing. You’ll take these drugs through a catheter inserted into a vein (IV). They include:

• Somatostatin
• Octreotide
• Orlistat

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

Recovery time

Mild leaks heal after the chyle drains, often in about a week. You may need to continue making changes to your diet for longer. This may last for as little as a week after surgery up to several months.

When should I see my healthcare provider?

Healthcare providers diagnose most chyle leaks in the hospital during recovery from surgery. But it’s always important to keep tabs on how you’re doing once you go home. Let your provider know right away if you have symptoms like:

• Chest pain or a feeling of pressure on your chest
• Fatigue
• Loss of appetite
• Shortness of breath
• Rapid weight loss

What can I expect 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 it heals. Most chyle leaks heal within a week or so with treatment.

The condition can become life-threatening if too much chyle leaks. At this point, you may need surgery to repair the damaged lymph vessel.

Your experience will depend on your general health, how big the leak is and other factors your care team will discuss with you.

Is there anything I can do to feel better?

Your healthcare provider will give you detailed instructions about diet and activity. Follow them carefully and keep any follow-up appointments. This will give the chyle leak the best chance to heal quickly. The sooner it heals, the better you’ll feel.