AKUTNI ASCEDENTNI MEDIJASTINITIS I FLEGMONA VRATA UZROKOVANI PSEUDOCISTOM PANKREASA: PRIKAZ SLUČAJA
Sažetak
Akutni medijastinitis spada u grupu najtežih infekcija sa visokom stopom mortaliteta. U najvećem broju slučajeva nastaje kao posledica descedentnog širenja infekcije iz usne duplje ili farinksa. Kao najčešće torakalne komplikacije bolesti pankreasa javljaju se reaktivni izlivi ili pneumonije. Nasuprot tome, komplikacije poput pankreasno-pleuralne fistule praćene masivnim izlivom ili hemotoraksom i ekstenzijom pseudociste u medijastinum retko se sreću. U poslednjih sedamdeset pet godina u literaturi je zabeleženo samo pedeset slučajeva širenja pseudociste u medijastinum; samo je u jednom slučaju došlo do širenja u predeo vrata. Prikazan je slučaj četrdesetpetogodišnjeg bolesnika kod kojeg je potvrđen akutni respiratorni distres sindrom sa razvojem enzimskog hidropneumotoraksa, medijastinitisom i flegmonom vrata uzrokovan pseudocistom pankreasa. Bolesnik je posle inicijalne dijagnostike podvrgnut urgentnoj operaciji u kojoj je učestvovao multidisciplinarni tim. Ascedentni medijastinitis uzrokovan pseudocistom pankreasa zahteva hitno hirurško lečenje, a rana detekcija i agresivni pristup u lečenju od presudnog su značaja. Terapija podrazumeva kombinaciju hirurškog debridmana sa antibioticima širokog spektra i adekvatnom suportivnom terapijom.
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