CASE HISTORY – April 2013

Mediastinitis caused by ruptured pancreatic pseudocyst

Authors: Edvard Garder, Ilmar Kaur, Tõnu Vanakesa, Asko Šeffer

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A 42-year-old man with a history of chronic alcohol abuse was admitted to the emergency department after presenting swelling of the neck, odynophagia, dyspnea and hoarse voice. Blood samples revealed intense inflammatory reaction. After a clinical examination and CT-scan mediastinitis was diagnosed. The progression of dyspnea and instable haemodynamics necessitated intubation of the patient and transferring to the central hospital. A more extensive CT-scan revealed two communicating abdominal pancreatic pseudocysts with the upper one reaching the mediastinal space and leading to mediastinitis. The patient was  operated using right-sided thoracotomy and upper median laparotomy: drainage of the pleural cavities, the mediastinum, and the abdominal pseudocyst was performed. I/v Tienam 0.5g x 4 was administered for antibacterial therapy. Postoperative recovery was rapid, although one more operation was needed to remove a part of the broken drain The AB therapy lasted 7 days and the patient was dicharged on the 13th day. The mediastinal pus culture yielded no microorganism. Four months later the patient`s blood levels of glycose and amylase were within the reference range.