Solving a disaster following coronary bypass operation

Clinical presentation A 72-year-old male patient underwent coronary bypass surgery and presented with atrial fibrillation upon completion of the operation. Intraoperative transesophageal echocardiography (TEE) was performed, followed by successful electric cardioversion. The initially stable patient developed a systemic inflammatory response syndrome on day 7 after the operation. The septic course progressed over the next days, necessitating reintubation and placement of a nasogastric feeding tube. Since the patient did not stabilise despite escalation of antibiotic therapy, he was referred to our department of general surgery. A CT scan of thorax and abdomen revealed the images shown in figure 1. Question What is the most likely cause of the CT scan findings? Answer CT scan revealed an abdominal abscess with free intra-abdominal air. Gastric perforation was suspected and the patient was taken to surgery. Laparotomy revealed an abscess in the omental bursa containing 5 L of...
Source: Gut - Category: Gastroenterology Authors: Tags: GUT Snapshot Editor ' s quiz: GI snapshot Source Type: research