Abstract Many modern surgical procedures involve the area near the distal portion of the thoracic duct, in both the neck and the upper mediastinal area. The distal portion of the duct is the most commonly injured, resulting in either a chylothorax or a chylous fistula unless recognized at the time of injury and repaired. Such injuries have been reported as complications of block dissections in the neck for tuberculous nodes or malignant tumor, scaleniotomy, esophageal resection, the Blalock operation for congenital pulmonary stenosis, radical breast amputation, operation for left-sided torticolis and during left phrenicoexeresis.* Anatomical studies have indicated that variations occur which may account for some of the injuries.9 Methods used to investigate the variations have included x-ray visualization of the duct18 and cadaver dissections.† Seventy-five cadavers used for anatomical dissection by the medical students of the University of Tennessee during the years 1950 through 1953 were studied for References 1. References 4, 5, 8, 15, 17, 21, and 22. 2. References 9 and 20. 3. References 14 and 16. 4. References 1-3. 5. References 6, 7, 10, 12, 13, 19, and 23. 6. References 9, 18, and 20. 7. Anson, B. J.; Morgan, E. H., and McVay, C. B.: The Anatomy of the Hernial Regions: I. Inguinal Hernia , Surg. Gynec. & Obst. 89:417-423 ( (Oct.) ) 1949. 8. Anson, B. J.; Reimann, A. F., and Swigart, L. L.: Anatomy of Hernial Regions: II. Femoral Hernia , Surg. Gynec. & Obst. 89:753-763 ( (Dec.) ) 1949. 9. Anson, B. J.; McCormack, L. J., and Cleveland, H. C.: The Anatomy of the Hernial Regions: III. Obturator Hernia and General Considerations , Surg. Gynec. & Obst. 90:31-38 ( (Jan.) ) 1950. 10. Barnes, H. A.: Scalenus Anticus Syndrome , U. S. Nav. M. Bull. 44:773-776 ( (April) ) 1945. 11. Bressler, S.; Wiener, D., and Thompson, S. A.: Traumatic Chylothorax Following Esophageal Resection , J. Thoracic Surg. 26:321-324 ( (Sept.) ) 1953. 12. Carey, J. M., and Hollinshead, W. H.: An Anatomic Study of the Esophageal Hiatus , Surg. Gynec. & Obst. 100:196-200 ( (Feb.) ) 1955. 13. Cauldwell, E. W.; Siekert, R. G.; Lininger, R. E., and Anson, B. J.: The Bronchial Arteries: Anatonic Study of 150 Human Cadavers , Surg. Gynec. & Obst. 86:395-412 ( (April) ) 1948. 14. Cushing, H.: Operative Wounds of the Thoracic Duct: Report of a Case with Suture of the Duct , Am. Surgeon 27:719-728, 1898. 15. Davis, H. K.: Statistical Study of Thoracic Duct in Man , Am. J. Anat. 17:211-244 ( (Jan.) ) 1915. 16. Doubilet, H.; Shafiroff, B.G.P., and Mulholland, J. H.: The Anatomy of the Periesophageal Vagi , Ann. Surg. 127:128-135 ( (Jan.) ) 1948. 17. Douglass, B. E.; Baggenstoss, A. H., and Hollinshead, W. H.: The Anatomy of the Portal Vein and its Tributaries , Surg. Gynec. & Obst. 91:562-576 ( (Nov.) ) 1950. 18. Edwards, E. A., and Robuck, J. D., Jr.: Applied Anatomy of the Femoral Vein and Its Tributaries , Surg. Gynec. & Obst. 85:547-557 ( (Nov.) ) 1947. 19. Gross, R. E., and Ware, P. F.: The Surgical Significance of Aortic Arch Anomolies , Surg. Gynec. & Obst. 83:435-448 ( (Oct.) ) 1946. 20. Hicken, N. F.; Coray, Q. B., and Franz, B.: Anatomic Variations of the Extrahepatic Biliary System as Seen by Cholangiographic Studies , Surg. Gynec. & Obst. 88:577-584 ( (May) ) 1949. 21. Hodge, G. B., and Bridges, H.: Surgical Management of Thoracic Duct Injuries: Experimental Study with Clinical Application , Surgery 24:805-810 ( (Nov.) ) 1948. 22. Johnston, E. V., and Anson, B. J.: Variations in the Formation and Vascular Relationships of the Bile Ducts , Surg. Gynec. & Obst. 94:669-686 ( (June) ) 1952. 23. Koon, E.: Injury During Operation for Left Sided Torticolis , Zentralbl. Chir. 70:840 ( (June) ) 1943. 24. Kornblum, D.: Attempt of Roentgenographic Visualization of Thoracic Duct and Cisterna Chyli , Radiology 39:395-399 ( (Oct.) ) 1942. 25. Lowenberg, R. I., and Morton, D. E.: The Anatomic and Surgical Significance of the Lumbar Sympathetic Nervous System , Ann. Surg. 133:525-532 ( (April) ) 1951. 26. Lowman, R. M.; Hoogerhyde, J.; Waters, R. L., and Grant, C.: Traumatic Chylothorax: Roentgen Aspects of This Problem Am. J. Roentgenol. 65:529-546 ( (April) ) 1951. 27. Olim, C. B.: Experiences in the Surgical Treatment of Congenital Pulmonary Stenosis , Am. Surgeon 17:245-254 ( (March) ) 1951. 28. Porta, G.: Injury During Phrenico-Exeresis in Pulmonary Tuberculosis , Ann. 1st. Calvo Forlanini 4:175-182 ( (March-April) ) 1940. 29. Swigart, L. L.; Siekert, R. G.; Hambley, W. C., and Anson, B. J.: The Esophageal Arteries: Anatomic Study of 150 Specimens , Surg. Gynec. & Obst. 90:234-243 ( (Feb.) ) 1950.
A.M.A. Archives Surgery – American Medical Association
Published: Dec 1, 1956
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