Pneumoperitoneum, pneumomediastinum and subcutaneous emphysema following argon plasma coagulation treatment of colonic angioectasia.

INTRODUCTION: The paper presents unusual symptoms as a complication of therapeutic colonoscopy. CASE REPORT: A 70-year-old polymorbid female patient in chronic dialysis program underwent argon plasma coagulation treatment of leaking angioectasias in the cecum and ascending colon. Shortly after the procedure she presented with shortness of breath and subcutaneous emphysema of the neck which was initially misdiagnosed as swelling. Further tests revealed pneumoperitoneum, subcutaneous emphysema and pneumomediastinum. Considering the high risks for our patient (comorbidities, obesity), a laparoscopic approach was indicated. During laparoscopy neither peritonitis nor intestinal perforation were found. The patient recovered without complications after further complex treatment. CONCLUSION: Shortness of breath and subcutaneous emphysema are not typically among the first symptoms of colonoscopic perforation. Our case confirms that we should bear this complication in mind and when suspected, the diagnostic process should be started without delay.

Postpneumonectomy MRSA empyema treated with vacuum therapy - case report and literature review.

INTRODUCTION: Postpneumonectomy empyema is one of serious complications with high mortality and lethality. In this paper, the authors describe the treatment of methicillin-resistant Staphylococcus aureus-induced postpneumonectomy empyema by vacuum therapy in a patient operated on for malignant pleural mesothelioma. CASE REPORT: A 64-year-old patient was operated on at our clinic for epithelioid mesothelioma of the right pleural cavity. We performed extrapleural pneumonectomy with intraoperative hyperthermic intrathoracic chemotherapy. Seven weeks after surgery the patient was readmitted for right pleural cavity empyema caused by methicillin-resistant Staphylococcus aureus (MRSA). Following pleural cavity debridement and mesh explantation we applied vacuum therapy. In total, we performed 4 dressing changes with final application of an antibiotic solution into the pleural cavity and wound closure. The patient showed no evidence of recurrent empyema during subsequent 12-month follow-up and underwent chemotherapy. CONCLUSION: Vacuum therapy is an effective treatment of postpneumonectomy empyema in patients without a bronchopleural fistula; nevertheless, specific postpneumonectomy patient care is required.

Bronchogenic cyst of gastric cardia - case report and literature review.

INTRODUCTION: Intramural bronchogenic cysts of the esophagus are very rare. They are mostly found in the upper mediastinum. Symptoms are caused by compression of surrounding structures by the cyst or complications of the cyst. However, the majority are asymptomatic. CASE REPORT: We describe the case of a 30-year-old female patient who underwent surgery at our institution for a tumor of the gastric cardia protruding intraluminally. The tumor was found incidentally during upper endoscopy before a planned bariatric surgery. A solid lesion originating from the muscle layer of the cardia wall was described based on endoscopic ultrasound. A CT scan did not show any infiltration of surrounding structures or disease dissemination. We performed laparoscopic enucleation of the tumor combined with partial fundoplication to close the defect in the muscular layer of the esophagus. Histopathology report surprisingly confirmed a bronchogenic cyst in the gastric cardia wall. The patient healed primarily and was soon discharged without complications. Two months later she underwent sleeve gastrectomy for obesity. Seven months following the bronchogenic cyst enucleation an endoscopic balloon dilation was performed on the patient with good effect upon diagnosing a relative gastric cardia stenosis. CONCLUSION: The diagnosis of esophageal bronchogenic cysts is usually difficult. Histopathology results are crucial to determine the definitive diagnosis. Endoscopy and imaging techniques, including endoscopic ultrasound, play an important role in the diagnostic process. Most authors prefer complete removal of the cyst, endoscopic or surgical, due to possible cyst complications, diagnostic uncertainty, and certainly in symptomatic patients. The complication rate is minimal.