CASE 657: MEDIASTINAL ABSCESS, Dr PHAN THANH HAI, Dr PHAN NGUYEN THIEN CHAU, Dr LE HUU LINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 69 year-old male patient enters Medic Center with ten days of fever,  thoracic pain and trouble ingestion. He was managed as gastritis but nothing change.

Blood tests show an infectious syndrome, while EKG, cardiac ultrasound results are in normal limits.

MSCT represents  a # 3 centimeter mass containing air  which is an upper mediastinal abscess with  some calcified foci inside due to a fistula of 1/3 middle part of esophagus.

Surgeon advises immediatly transferring the patient to a surgery hospital.

Gastroendoscopy shows a thickening lesion of middle esophagus and a normal chest X-Ray.

A MSCT is performed to prove the mediastinal abscess, and a bronchoscopy is done to rule out lesion from lung and airways. 

A decision of conservative treatment with antibiotics and a gastrostomy are noted to keep nourrishing the patient which is lasting from now to a half and one month later.

Mediastinal abscess is in recovery phase, reduces its size with calcifications, in two times of re-examination.

This is a mediastinal abscess case due to middle esophagus fistula which is unveiled the cause. 

Clinical clues are fever and thoracic pain and trouble ingestion. The role of MSCT and endogastroscopy are more clearer than chest X-Ray and cardiac ultrasound. Gastrostomy and medical treatment are well enough to help the patient avoiding an unnecessary operation with risks.

And patient remains well and can eating normally by mouth in happiness. 

May the abscess come back?

CASE 656: BOWEL VOLVULUS due to MESENTERIC CYST, Dr PHAN THANH HẢI, Dr TRẦN NGÂN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 

A 23 year-old male patient with periumbilical pain and left flank pain for 5 days and vomiting. 

Ultrasound detects a cystic mass # 17.9x11.2 centimeter from his navel to pubis, and jejunum dilatation with obstruction sign (washing machine sign). The cystic mass contents fluid and septation with vascular sign on its walls. The cause of bowel obstruction was noted by a non-dilated bowel loop at the mesenteric root with whirpool sign.

There is not  bowel malrotation nor duplication cyst, so the ultrasound findings is bowel volvulus due to a mesenteric cyst.

MSCT confirms bowel volvulus due to a mesenteric cyst later.

Open surgery is done after endoscopic investigation. The cystic mass with yellowish fluid and a part of bowel are removed. Patient remains well post-op.

The histopathological report is a benign cyst with inflammation of the mesentery.

 

Bowel volvulus is still a rare entity especially in young adult.  Mesenteric cyst causes bowel volvulus may happen in emergency room in case of ruling out bowel malrotation, urachal cyst, Meckel diverticulum.