[HSF] anaerobic late mediastinitis

[prasannasimha]

Keep chest open and I will tell something that will make your blood 
curdle but has worked well.
Apply fresh curds (Yoghurt) to the wound. This will displace the E coli 
and the colonized lactobacillus is nonpathogenic ansd will get 
eliminated. Later you can mobilize flaps/ close with drains.
IV antibiotics after mediastinal cultures etc etc are obvious.
Look for diverticulitis especially if a meat eater.
erdinç naseri wrote:
>
> 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
>
>
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