Role of octreotide in the management of chylous pleural effusion in children: Experience with two cases

We would like to report the successful use of octreotide in the treatment of chylothorax secondary to noncardiac surgery in two children.We would also like to emphasize that conservative treatment with chest tubes, parenteral nutrition, and octreotide is simple and is the initial treatment in most cases, whereas surgical intervention is only required secondarily.The first case involved a 1-year-old girl with type C esophageal atresia who presented with symptoms of dysphagia and weight loss.A contrast study and endoscopy revealed a stricture at the anastomotic site, requiring right posterolateral thoracotomy and stricturoplasty to be performed because an attempt at endoscopic dilatation failed.Over the next 24 h, the chest drain output turned milky, and the biochemical analyses revealed chylothorax.The patient was kept fasting, and subcutaneous octreotide was started at a dose of 10 µg/kg body weight 3 times a day.The drain output gradually decreased, and the chest X-ray cleared.Octreotide was gradually tapered after the 7 th day and stopped on the 11 th day.The chest tube was removed on the 13 th post-operative day, and the patient was discharged on a diet rich in medium-chain triglycerides.The second case was a 1.5-year-old female who underwent surgery for a residual cystic hygroma involving the left neck, chest, and shoulder, following serial intralesional bleomycin therapy.This mass compressed the left internal jugular vein and extended to the main pulmonary artery, surrounding the aortic arch, and the left innominate vein with outward displacement of the trachea and esophagus.She developed respiratory distress and tachypnea on the 3 rd post-operative day and on the 6 th day after surgery, her chest tube showed a milky fluid which on biochemical analysis confirmed the diagnosis of left chylothorax.Subcutaneous administration of octreotide at 10 µg/kg body weight was initiated, and she was initially kept fasting and later switched to medium-chain triglyceride feed through a nasogastric tube.The chest tube drainage decreased over the next 10 days.Octreotide was tapered gradually, and the chest tube was removed on the 19 th post-operative day. Figure 1 summarizes the daily drain output improvement achieved in both cases.