PERICARDIAL STERNAL FISTULA: SUBXIPHOID THORACOSCOPIC APPROACH emmanuel.penag@incmnsz.mx

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PERICARDIAL STERNAL FISTULA: SUBXIPHOID THORACOSCOPIC APPROACH

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Mexico

Oral or Poster

Cutaneo pericardial and sternal pericardial fistula It may be associated to osteomyelitis of the sternum either as a primary condition or secondary to median thoracotomy after cardiac surgery. Deep sternal wound infections appear as a complication in 0.2 to 4.4% of cases

Male from 7th decade of life history of diabetes and hypertension. coronary artery disease that reguired surgery for revascularization. He went to the outpatient clinic due to the leakage of dark liguid fetid material through a skin defect at the stenum. CT reported fistulos defects with communication of the mediastinum, pericardium towards the sternum with data of osteomyelitis that affects both laminae of the sternum and sternocostal joint. Prior to surgery management with infectology was performed

Thoracoscopic assisted surgery to remove the complete infected sternal bone. the fistula site that began in the epicardium, which was resected with repair with vascular suture, partial sternotomy and resection of affected joints. Mesh and rotation of pectoral muscles were placed as well as drains with passive suction. culture by gram-negative that improved with local dreinage, local lavage and systemic antibiotic

Pericardial Sternal fistula should be assumed and ruled out in anyone with a recent history of cardiac or mediastinal surgery and a cutaneous effusion with or without osteomyelitis, signs of sepsis, pneumomediastinum, pneumopericardium, or chest pain