Octreotide
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Lack of efficacy: case report A 48-year-old man exhibited lack of efficacy during treatment with octreotide for chylothorax. The man was brought to the hospital via ambulance due to severe persistent back pain and fever from one month (current presentation). Eight months prior to the current presentation, he had undergone an emergency ascending arch aortic replacement due to Stanford type-A acute aortic dissection. After the procedure, he developed mediastinitis related to Serratia marcescens; hence, he underwent repeat thoracotomy. He was then discharged on unspecified antibacterials. Following the current presentation, various examinations were performed, and he was diagnosed with artificial vascular infection due to prolonged mediastinitis and an infectious pseudo-aneurysm. Therefore, an emergency re-ascending arch aortic replacement surgery was performed on the same day. After the procedure, no neurological abnormalities were noted on day 2. Mechanical ventilation was removed on day 3, and a diet was started on day 5. However, from the following day, the pericardium and left thoracic cavity drainage turned milky white, and he was diagnosed with chylothorax. On admission day 8, he was fasted and initiated on central venous hyperalimentation. Hence, his treatment was started with octreotide [octreotide acetate] 300µg daily on the following day [route not stated]. However, no improvement was noted, and the drainage fluid changed from chyle to serous. Therefore, he underwent a surgery as treatment of the chylothorax. The procedure was uneventful, and after the procedure, an unspecified antimicrobial treatment was started. On the day 53 of admission, he was discharged home. Kanamori T, et al. Surgical Treatment for Postoperative Chylothorax after Aortic Arch Replacement via Median Sternotomy. Kyobu Geka. The Japanese Journal of Thoracic Surgery 73: 197-201, No. 3, Mar 2020. Available from: URL: https://www.researchgate.net/ publication/341355460_Surgical_Treatment_for_Postoperative_Chylothorax_after_Aortic_Arch_Replacement_via_Median_Sternotomy [Japanese; summarised from a 803498449 translation]
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Reactions 29 Aug 2020 No. 1819
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