Idiopathic congenital chylothorax is a rare condition2
and is usually a transient condition that resolves by cessation of lymphatic flow in the thorax. Management is predominantly conservative and, in resistant cases, pleurodesis, ligation of the thoracic duct or placement of pleuroperitoneal shunts may be considered. However, the timing of surgery is not uniformly defined and is not risk-free of complications.5,7,8
Some case reports have been described regarding the use of octreotide as an alternative treatment to infants with persistent chylothorax.10–14
Octreotide is an octopeptide analogue of somatostatin with a longer half-life.6
Although the exact mechanism of action of octreotide is not understood, it may act on somatostatin receptors in the splanchnic circulation, and decrease lymph fluid production through a reduction in gastric, intestinal and pancreatic secretions or by a decrease in hepatic venous pressure and splanchnic blood flow.14
Octreotide is prescribed as an anti-secretory agent and has been used in the treatment of postoperative chylothorax in paediatric patients requiring cardiac surgery10
with no reports of recurrent chyle accumulation or significant adverse effects of treatment.12
The chylothorax in our case resolved completely, with prompt resolution of the effusion coincidental to the use of octreotide, with no adverse effect encountered. These findings are similar to other case reports of octreotide use in congenital chylothorax management10–14
and highlights that the treatment can be stopped soon after resolution of chylothorax with achievement of full enteral feeds. Besides the apparent safety of octreotide treatment, it is important to insure the adequate monitoring of its side-effects.15
In conclusion, octreotide appears to offer a very attractive and effective alternative for congenital chylothorax. As case numbers are small, multicentric controlled trials are required in order to substantiate these anecdotal results and to ascertain the optimal therapeutic schema and further guidelines in congenital chylothorax.
- Idiopathic congenital chylothorax should be considered in persistent pleural effusion in the neonate.
- After conservative treatment octreotide should be considered in persistent chylous effusion.
- Besides the apparent safety of octreotide, we should be aware of its side-effects.