AN 82-YEAR-OLD WOMAN in former good health presented with dysphagia, which she had been experiencing for 2 months. She could only tolerate a liquid diet. Physical examination was unremarkable. A barium swallow study showed a constant irregular narrowing in the middle third of the esophagus. Endoscopy revealed an ulcerative tumor at 26 cm from the incisor, and a biopsy identified it as a squamous cell carcinoma. Staging investigations did not show evidence of distant metastases, and a Lewis-Tanner esophagectomy was performed through a fifth space posterolateral thoracotomy. During the operation, a localized tumor in the mid-esophagus was found. Esophagectomy was performed. At a short distance above the diaphragmatic hiatus, the thoracic duct was identified. It was first tied and then marked with a metal clip. After the operation, the daily chest drain output exceeded 300 mL, and on laboratory investigation the fluid was confirmed to be chyle. Leakage of chyle into the left thoracic cavity was also evident, which required an additional chest tube for drainage. The chylothorax was managed initially with total parental nutrition and pleural drainage. However, drainage was persistent for more than 2 weeks. A lymphangiogram was performed to locate the position of chyle leakage (Fig 1). It showed leakage of contrast near the site of the initial prophylactic thoracic duct ligation. Surgical re-exploration was carried out. The patient was given 200 mL of milk via a naso-gastric tube 2 hours before being transferred to the operating room. A small lower right-sided 7th space posterolateral thoracotomy was made. This avoided adhesion under the previous 5th space thoracotomy, and it was also closer to the intended site of thoracic ligation. A pool of milky fluid was found inside the thoracic cavity (Fig 2). The chyle leak was identified just proximal to where the thoracic duct was clipped during the first operation. The leakage was probably caused by incomplete clipping of adjacent lymphatic tissues next to the thoracic duct. The supradiaphragmatic and periaortic tissue at the front and both sides of the aorta proximal to the leakage were ligated, and fibrin glue was applied. No chyle leakage was found before the wound closure. After this operation, chest drainage decreased gradually, and both drains were removed within a week. The patient was discharged from the hospital. Chylothorax after esophagectomy