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Disorders of the Mediastinum: Fellow Case Report Slide: Disorders of the Mediastinum |

Respiratory and Circulatory Failure From Abscess-Related Pneumomediastinum and Overflow Pneumoperitoneum

Matthew Nolan, MD; John Park, MD
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Mayo Clinic, Rochester, MN


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(4_S):541A. doi:10.1016/j.chest.2016.08.559
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SESSION TITLE: Fellow Case Report Slide: Disorders of the Mediastinum

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Tuesday, October 25, 2016 at 07:30 AM - 08:30 AM

INTRODUCTION: Gastroesophageal perforation is an infrequent but serious complication following laparoscopic hiatal hernia repair1, which can lead to mediastinal abscess.

CASE PRESENTATION: A 64 year old male presented with esophageal food impaction from an intrathoracic gastric volvulus. Four days following disempaction and laparoscopic hiatal hernia repair he developed hypoxia and sepsis. After intubation he had unanticipated severe hypotension. Testing confirmed a large gas-forming mediastinal abscess from a gastric perforation, which was treated with endoscopic stitching and stenting with complete defect closure. The next day he had worsening abdominal distention, rising airway pressures, and hypotension. CT scan showed enlargement of the mediastinal abscess with pneumomediastinum and new pneumoperitoneum from the diaphragm to the scrotum (Figure). Surgical debridement, mediastinal chest tube placement, and needle paracentesis for abdominal air dramatically improved peak airway pressures and hemodynamics.

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