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Case Reports
. 2014 Oct 28;20(40):14997-5000.
doi: 10.3748/wjg.v20.i40.14997.

Acute mediastinitis arising from pancreatic mediastinal fistula in recurrent pancreatitis

In Soo Choe  1 , Yong Seok Kim  1 , Tae Hee Lee  1 , Sun Moon Kim  1 , Kyung Ho Song  1 , Hoon Sup Koo  1 , Jung Ho Park  1 , Jin Sil Pyo  1 , Ji Yeong Kim  1 , In Seok Choi  1
Affiliations
Case Reports

Acute mediastinitis arising from pancreatic mediastinal fistula in recurrent pancreatitis

In Soo Choe et al. World J Gastroenterol. .

Abstract

Acute mediastinitis is a fatal disease that usually originates from esophageal perforation and surgical infection. Rare cases of descending necrotizing mediastinitis can occur following oral cavity and pharynx infection or can be a complication of pancreatitis. The most common thoracic complications of pancreatic disease are reactive pleural effusion and pneumonia, while rare complications include thoracic conditions, such as pancreaticopleural fistula with massive pleural effusion or hemothorax and extension of pseudocyst into the mediastinum. There have been no reports of acute mediastinitis originating from pancreatitis in South Korea. In this report, we present the case of a 50-year-old female suffering from acute mediastinitis with pleural effusion arising from recurrent pancreatitis that improved after surgical intervention.

Keywords: Complication; Fistula; Mediastinitis; Pancreatitis; Recurrent.

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Figures

Figure 1
Figure 1
Chest computed tomography of the patient. The black arrow indicates mediastinitis with fat lysis due to pseudocyst rupture. The white arrow indicates loculated effusion in the right anterior paramediastinal space. The black arrowhead indicates pleural effusion and the white arrowhead indicates pneumonic infiltration of the paracardiac area.
Figure 2
Figure 2
Magnetic resonance cholangiopancreatography revealed an 8-mm pseudocyst at the pancreatic tail connected with the distal pancreatic duct (arrow). This pseudocyst communicated with another 2.6-cm pseudocyst in the right paraesophageal area. This second pseudocyst ruptured at the paraesophageal hiatus and extended to the right paracardiac area in the right middle mediastinum (arrowhead).
Figure 3
Figure 3
Endoscopic retrograde cholangiopancreatography of the patient. The white arrow indicates that the guide wire did not pass through the mid-pancreatic area.
Figure 4
Figure 4
Laparoscopic distal pancreatectomy revealed severe adhesion due to chronic pancreatitis at the distal pancreas and stomach. Fistula formation and pseudocyst rupture were seen. Adhesiolysis and fistula resection were performed.
See this image and copyright information in PMC

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