Following elective transthoracic oesophagectomy in a 75-year old female, sudden haemodynamic instability occurred on the second postoperative day, requiring re-intubation and inotropic support. A large mediastinal fluid collection with mechanical compression of the heart was found with computed tomography imaging of the thorax. Restoration of cardiac function was noted following successful surgical fluid drainage. Subsequent ligation of the thoracic duct because of persisting leakage of chylous fluid resulted in final patient recovery. Chyle leakage following oesophagogastrectomy usually results in pleural effusion. However, a chylomediastinum may sometimes occur with potentially significant haemodynamic consequences. Recognition of the thoracic duct at initial surgery with or without prophylactic ligation is crucial for preventing major complications caused by chyle leakage.
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