Chyle flow varies dramatically depending on quantity and quality of oral intake. During times of starvation, chyle flow is minimal. After meals, especially those with high contents of long chain fatty acids, chyle flow increases dramatically. This basic knowledge provides the rationale for controlling dietary intake as part of the treatment of this disease. Because of the relatively low incidence of chyle fistulas, a high index of suspicion is required to make a timely diagnosis.
Diagnosis usually is made after the patient has recovered from the injury and started eating.
In addition, half of the 4 liters of lymph draining through the cisterna chyli and thoracic duct originates from the intestinal and hepatic lymphatics. The cisterna chyli is found on the posterolateral edge to the right of the aorta at the level of vertebral bodies T12, L1, L2, and L3 as lymphatics from the mesentery, intercostals, and lumbar regions coalesce in the retroperitoneal space. At approximately L1, the cisterna chyle ascends, becoming the thoracic duct. The duct then enters the posterior mediastinum, crosses at T4 into the left retropleural space, and continues in a cephalad direction. Fistulas arising in the neck are easier to access and identify than those that occur in the abdomen or thorax.