Herniation of transverse colon into mediastinum after pedicled omental grafting for mediastinitis: report of a case

Abstract

We describe a rare complication and the treating experience of it after pedicled omental grafting for mediastinitis. The patient was diagnosed as an acute mediastinitis soon after the total arch replacement was performed. A two-staged strategy to treat postoperative mediastinitis was scheduled, i.e., the setting up of a vacuum-assisted closure system until the improvement of inflammation followed by wound closure with pedicled omental grafting. The treatment for acute mediastinitis was successful and the patient followed a favorable postoperative course. During the follow-up, chest X-ray film suggested the gradual enlargement of mediastinum and CT showed the herniation of transverse colon into mediastinum. Surgical correction for the hernia was scheduled and performed successfully by the laparoscopic procedure to prevent a possible cardiac and pulmonary dysfunction.

Current indications for the intrathoracic transposition of the omentum

“…The possibility to mobilize the OF using a laparoscopic approach makes this flap even more attractive by avoiding the morbidity associated with laparotomy [10]. A specific but rare complication of OP for mediastinitis and deep sternal wound infections is the possibility to develop a retrosternal herniation of the abdominal viscera through the diaphragmatic defect; reoperation and treatment of this particular hernia is possible without compromising the OF [11].…”

Herniation of the transverse colon into the mediastinum after the use of an omental flap for mediastinitis

“…Transverse colon herniation into the mediastinum after the use of an omental flap is rarely reported . Negative pressure of the mediastinum may be a cause of predisposition for organ herniation.…”