[HSF] anaerobic late mediastinitis

[erdinç naseri]

Dear forum members,
Opinion requested in the following case:
76 y/o male applied for CABG and ascending aortic aneurysm(6.5 cmm at STJ 
),No AI.Supracoronary  ascending aortic replacement with tubular graft and 
CABG X 1 one month ago.Had abdominal distention at postop 5.th day. No 
fever.Diagnosed as paralytic ileus. stoped oral intake and followed by 
general surgery guys for one week conservatively.WBC 4000 considered normal 
by them but I told them that this is relative neutropenia in open heart 
surgery ( ususally 12-20000 in postop period).After one week started oral 
feeding and discharged.Applied 2 days ago with anemia, weakness and 
abdominal distention.Hospitalized by my colleagues and followed medicaly( 
Genaral surgeons agreed on medical follow up),I saw the patient yesterday.No 
fever with Partial dehiscence and wound was dirty( oozing bad smelly 
fluid).Immediately taken to ICU and monitorized.Started inotropics for low 
cardiac out put and took the patient to the operation room.Opened the 
sternum .Very fetid odor and semiclear fluid.Grafts intact ,coronary graft 
open.Deep bradycardia and hypotension and arrest followed by mannual 
massage.Cardiac activity returned but with maximum inotropic agents.Opened 
both pleura and put a tube in each and one in suprasternal notch for 
irrigation.He is in ICU  with unremitting fever (39-40)and Culture revealed 
E.coli.
erdinc