[HSF] anaerobic late mediastinitis

Ani Anyanwu anianyanwu at hotmail.com
Fri Mar 23 18:36:20 EDT 2007 

Dead gut is easy to confirm/exclude. I am not sure though of the certainty of concluding that this is an anaerobic infection without culture evidence.

Regarding therapy, if you are not to replace the aortic graft, consider covering it early with omentum or pectoralis as will help deliver antibiotics and locally control infection around the graft (which aside from uncontrolled systemic sepsis will be the likely source of death).

Ani
  ----- Original Message ----- 
  From: erdinç naseri<mailto:enaseri at hotmail.com.tr> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Friday, March 23, 2007 4:10 PM
  Subject: RE: [HSF] anaerobic late mediastinitis


  Ajit,
  Theoretically you are right but this man wouldn't tolerate any surgery other 
  than sternal revision during which he developed cardiac arrest.I am curious 
  about the pathogenesis of the infection.Bacterial translocation through dead 
  gut?
  erdinc


  >From: "Ajit Damle" <damle at cableone.net<mailto:damle at cableone.net>>
  >Reply-To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
  >To: <OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>>
  >Subject: RE: [HSF] anaerobic late mediastinitis
  >Date: Fri, 23 Mar 2007 14:42:09 -0500
  >
  >I am too stunned to comment on "Yogurt in mediastinum".
  >
  >To my unsophisticated mind it seems that infection (leading to eventual
  >death) will not be controlled unless the prosthetic graft is replaced with 
  >a
  >homograft, if it does.
  >
  >Does anyone know if infection in a vascular graft in such a situation can 
  >be
  >controlled without replacing it?
  >
  >Ajit Damle
  >
  >
  >
  >-----Original Message-----
  >From: openheart-l-bounces at lists.hsforum.com<mailto:openheart-l-bounces at lists.hsforum.com>
  >[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of prasannasimha
  >Sent: Friday, March 23, 2007 11:04 AM
  >To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
  >Subject: Re: [HSF] anaerobic late mediastinitis
  >
  >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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