Mediastinitis with an infection of methicillin-resistant Staphylococcus aureus treated by an omental transfer following CABG using a right gastroepiploic arterial graft: report of a case.
We report a case of severe mediastinitis infected by methicillin-resistant Staphylococcus aureus (MRSA) after a coronary arterial bypass using the internal thoracic arteries and the right gastroepiploic artery (RGEA) in which mediastinitis was treated by an omental transfer. The patient was a 60-year-old man diagnosed as having an acute myocardial infarction of the left anterior wall. There was severe coronary stenosis of three vessels involving the left main trunk. The patient underwent a coronary arterial bypass with four grafts using the internal thoracic arteries, the RGEA, and the saphenous vein. Postoperative heart failure led to wound infection, resulting in mediastinitis infected by MRSA. Debridement and immediate closure with omental drainage was successfully performed without irrigation. After the establishment of the RGEA graft, the omentum is still viable and usable for mediastinal drainage.
Sueda
T
T
First Department of Surgery, Hiroshima University School of Medicine, Japan.
Kanehiro
K
K
Morita
S
S
Matsuura
Y
Y
D000009:Abdominal Muscles / Q000098:blood supply*; D001158:Arteries / Q000637:transplantation; D001026:Coronary Artery Bypass; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000382:microbiology / Q000601:surgery*; D016106:Methicillin Resistance; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery; D009852:Omentum / Q000098:blood supply / Q000637:transplantation*; D013203:Staphylococcal Infections / Q000382:microbiology / Q000601:surgery*; D013211:Staphylococcus aureus / Q000187:drug effects; D013530:Surgical Wound Infection / Q000382:microbiology / Q000601:surgery*