縦隔内膵仮性囊胞に伴う縦隔炎に対する胸腔鏡下ドレナージ

Mediastinitis Associated with Mediastinal Pancreatic Pseudocyst Successfully Treated by Thoracoscopic Mediastinal Drainage

慢性膵炎の急性増悪に伴い膵仮性囊胞が後腹膜腔から縦隔内へ進展する場合がある．われわれは，縦隔内膵仮性囊胞を伴う縦隔炎に対して胸腔鏡下での縦隔ドレナージを行った症例を経験したので，若干の文献的考察を交えて報告する．

Pancreatic pseudocysts rarely extend to the mediastinum and can be fatal if mediastinitis is complicated. In this report, we describe a case of mediastinitis associated with mediastinal pancreatic pseudocyst successfully treated by the thoracoscopic mediastinal drainage. The patient was a man in his 40s with a history of alcoholic acute pancreatitis. Chest and abdominal computed tomography （CT） scan taken for his complaints of back pain and dyspnea showed a pancreatic pseudocyst extending to the mediastinum. First, an endoscopic nasopancreatic drainage （ENPD） tube was placed, and then thoracoscopic mediastinal drainage was performed through the right thoracic cavity. After the operation, the pseudocyst in the mediastinum rapidly disappeared even though there was no drainage from the ENPD tube. Postoperative recovery of the patient was uneventful, and the patient was discharged on the 17th postoperatively day. This case suggests that the importance of prompt treatment for mediastinitis and the effectiveness of the thoracoscopic surgery.