Postoperative Milk Fistula Treated with Cabergoline

Abstract

A milk fistula is a tract between a lactiferous duct and the skin, and usually results from a surgical operation. Several hypotheses have been proposed to explain the pathologic process. We herein report a case of a 23-year-old breastfeeding mother who has consulted us for the evaluation of her mastalgia. Breast ultrasonography confirmed the presence of a 21- × 15-mm lobulated lesion with an irregular contour. A milk fistula developed on the 3rd postoperative day. Intensive wound care and administration of broad-spectrum antibiotics were then performed. Medical management of the fistula involved treatment with oral cabergoline, which was begun at 0.5 mg twice per week. Two weeks after the operation, the wound was totally clear of any drainage and subsequently healed spontaneously. However, milk fistula is an uncommon complication. Milk fistulas are usually treated with primary closure or heal by spontaneous granulation. Oral antibiotics are usually administered. In our case, cabergoline treatment with intensive wound care was effective without the need for primary closure.

Keywords

• Milk fistula
• cabergoline
• Postoperative

Kabergolinle Tedavi Edilen Postoperatif Süt Fistülü

Öz

Süt fistülü, laktiferöz bir kanal ile cilt arasında genellikle cerrahi sonrası oluşan bir yoldur. Oluşum sürecini açıklayan çeşitli hipotezler ortaya atılmıştır.23 yaşında emziren bir anne kliniğimize mastalji şikayeti ile başvurdu. Yapılan muayenede saptanan palpabl kitlenin ultrasonografisi 21x15 mm’lik lobüle irregüler sınırlı malign şüphesi taşıyan kitleyi ortaya koydu. Eksizyonel biyopsi sonrası 3. Günde süt fistülü gelişti. Yara pansumanı ve geniş spektrumlu antibiyotik başlandı. Süt fistülüne yönelik kabergolin 0,5 mg tablet haftada iki kez oral yolla uygulandı. Postoperatif ikinci haftada drenaj tamamen kesildi ve yara spontan olarak iyileşti. Süt fistülü her ne kadar yaygın olmasa da,can sıkıcı bir komplikasyondur.Fistüller,primer sütürasyon veya spontan granülasyonla iyileşir. Sıklıkla oral antibiyotikler kullanılır. Vakamızda kabergolin hassas yara bakımı tedavisi ile birlikte etkili olmuştur,fistül primer sütürasyona gerek kalmadan spontan granülasyonla iyileşmiştir

Anahtar Kelimeler

• Süt fistülü
• tedavi
• kabergolin
• Postoperatif

References

1. 1-Hanavadi S, Pereira G, Mansel RE How mammillary fistulas should be managed. Breast J. 2005;11(4):254-6. 2-Schackmuth EM, Harlow CL, Norton LW. Milk fistula:A complication after core breast biopsy. AJR Am J Roentgenol. 1993; 161(5):961-2. 3-Hornstein E, Skornick Y, Rozin R The management of breast carcinoma in pregnancy and lactation J Surg Oncol. 1982;21(3):179-82. 4-Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA. Diagnosis and Treatment of Hyperprolactinemia:An Endocrine Society Clinical Practice
2. Guideline. J Clin Endocrinol Metab. 2011;96(2):273-88. 5- Berná-Serna JD, Berná-Mestre JD, Piñero A. Sonographically guided triamcinolone injection for the treatment of chronic postoperative mammillary fistula. Br J Radiol. 2012;85(1020):1318 6- Berná-Serna JD, Berná-Mestre JD, Piñero A, Canteras M.
3. Efficacy of intralesional triamcinolone injection in the treatment of mammillary fistula: a prospective study. Acta Radiol. 2013;54(7):739-741.
4. Figure 2. Postoperative 21st, the fistula healed spontaneously by granulation after cabergoline treatment and cessation of breastfeeding Correspondence / YazışmaAdresi Ali Cihat YILDIRIM Turkish Ministry of Health, Ankara Diskapi Yildirim Beyazit Training and Research Hospital e -posta: [e-mail] Geliş Tarihi: 31.03.2013 Kabul Tarihi: 25.07.2013 11 Postoperative Milk Fistula Treated with Cabergoline