Abstract
Chronic encapsulated mediastinal abscess is an unusual complication of previous open heart surgery. We report on the case of a 79 year old male who presented with epigastric fistulization of an encapsulated anterior mediastinal abscess 12 years after a redo aortic valve replacement for prosthetic valve endocarditis. The encapsulated abscess and its complex branching tracts and the cutaneous fistula were excised completely except the thin longitudinal strip of the ascending aorta which formed part of the posterior wall of the infected tract. This was covered with transposed greater omentum based on right gastroepiploic artery pedicle. Patient remains fit and well 2 years after his operation.This report is unusual on account of the length of the interval between previous heart surgery and the infective complication, the presumed dormancy of the abscess for as long as 12 years, the complex course, branching tracts and the contents of the abscess, the remote fistulization of the abscess at a distant anatomical site and, finally, the principle of successfully covering an infected tract which formed the adventia of the ascending aorta with pedicled omentum in the hope of avoiding an ascending aortic replacement in a frail 79 year old man.In the entire English language literature, this report represents the longest interval between a heart operation and a sternal or mediastinal abscess
Highlights
Mediastinitis is a well known complication of open heart surgery
We report the unusual case of a chronic encapsulated mediastinal abscess presenting with cutaneous fistulization in the epigastrium 12 years following redo aortic valve replacement for prosthetic valve endocarditis
A 79 year old man presented with a discharging sinus in the epigastrium
Summary
Mediastinitis is a well known complication of open heart surgery. Chronic mediastinal abscess presenting years after the original heart operation is a medical curiosity. A 79 year old man presented with a discharging sinus in the epigastrium He had undergone a mechanical aortic valve replacement for aortic stenosis 14 years ago which was followed 2 years later by repeat mechanical aortic valve replacement for streptococcal prosthetic valve endocarditis. An MR scan confirmed a longitudinal retrosternal mass extending from mid ascending aorta to the diaphragm (figs 2 and 3) and cutaneous fistulization to the epigastrium through left rectus sheath. The inferior part of the tract, that had fistulized through the rectus sheath to the epigastric skin, was filled with yellow fresh pus and a piece of old temporary pacing wire Both the white cheesy material and the pus were sent separately for bacteriological analysis and both grew staphylococcus aureus. At follow up 2 years later, he remains fit and well
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