RESUMEN
Pericardiocutaneous fistula is a rare complication of cardiac surgery. A 35-year-old female presented with acute severe hemorrhage from a pericardiocutaneous fistula eight years following aortic valve replacement. Computed tomography showed a large, pericardial collection causing tamponade, connected to a smaller subcutaneous cavity, with a tract leading to the skin. The patient underwent emergency surgical exploration with removal of hematoma, hemostasis, and partial pericardectomy. One year following the operation, the patient remains stable. Factors in the development of pericardiocutaneous fistula were valve replacement, infection, and warfarin anticoagulation.
Asunto(s)
Taponamiento Cardíaco/etiología , Fístula Cutánea/etiología , Cardiopatías/etiología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Hemorragia/etiología , Adulto , Válvula Aórtica/cirugía , Taponamiento Cardíaco/cirugía , Enfermedad Crónica , Fístula Cutánea/cirugía , Femenino , Cardiopatías/cirugía , Enfermedades de las Válvulas Cardíacas/cirugía , Hemorragia/cirugía , Humanos , PericardioRESUMEN
Descending necrotising mediastinitis can complicate oropharyngeal infection and has a high associated mortality. We present three cases treated in our department and propose a treatment algorithm based on our experience and literature review. The primary oropharyngeal infection was peritonsillar abscess in two cases and odontogenic abscess in one. Two patients underwent cervicotomy and later thoracotomy. The third underwent cervicotomy with transcervical mediastinal drainage and later required pericardial drainage via a subxiphoid incision. All recovered fully and were discharged within 6 weeks. To enable successful treatment, diagnosis needs to be prompt and surgical drainage adequate. Thoracic management of the chest is essential.