Q: 63 year old male after partial pneumonectomy for lung cancer developed chylothorax. Patient is initially managed on TPN (Total Parenteral Nutrition). What dietary modification may help in such situation to transit to enteral feed? 


Answer:  Reduced fat diet 

 Reduced fat diet preferably less than ten grams/day may play the trick by decreasing the flow of chyle through the thoracic duct and helps in spontaneous closure of a thoracic duct leak. Reduced fat diet can be supplemented by medium chain triglycerides which are absorbed directly into intestinal cells and transported directly to the liver via the portal vein, bypassing the thoracic duct. 


 Reference: 

 Takuwa T, Yoshida J, Ono S, et al. Low-fat diet management strategy for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer. J Thorac Cardiovasc Surg 2013; 146:571.