Chyle leaks post oesophagectomy occur in around 7% of patients, although the clinical significance varies depending on the severity. However, the circular flow of a chyle leak draining into a leaking gastric conduit before again being excreted into the thorax via disrupted lymphatic channels is an extraordinary situation.
We present the case of a 68 year old man who presented with advanced oesophageal cancer. He underwent a radical oesophagectomy after neoadjuvant treatment. An early chyle leak was identified, treated and apparently resolved, although the patient did not recover as expected. Diagnosing and treating the chyle leak that was internally draining was challenging due to a lack of normal localising signs. Radiological techniques were employed to embolise the duct but were unsuccessful. Ultimately, the thoracic duct was surgically ligated; this enabled the gastric conduit leak to heal, and the patient to recover from a complicated post-operative course and be discharged home. This case highlights the severe morbidity that can be associated with a chyle leak and the range of treatment modalities that may be required.