Pneumomediastinum and pneumopericardium 11 days after Whipple procedure. A case report and review if the literature

Highlights

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  Spontaneous Pneumomediastinum is a rare disease.

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  Combination with Pneumopericardium has not been reported yet.

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  There are no clear guidelines for diagnosis and treatment.

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  Conservative treatment with close monitoring is most of the times sufficient.

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  In surgical patients an upgraded diagnostic and treatment plan could be necessary.

Abstract

Introduction

Spontaneous pneumomediastinum (SPM) is a rare condition classified as free air in the mediastinum in the absence of any precipitating cause. This is the first time that a synchronous presence of pneumopericardium is described. To date, there are no clear guidelines for diagnosis and treatment.

Presentation of a case

A 34-year old Caucasian male patient presented to our institution with a recently diagnosed pancreatic adenocarcinoma. He underwent an uneventful pancreaticoduodenectomy (Whipple procedure). Preoperative and intraoperative chest X-Ray after a central line placement were normal. The postoperative course was uneventful, but few hours before his discharge he presented an acute tachycardia and tachypnea with hypocapnia and a transient loss of consciousness. The full-body CT scan revealed a pneumomediastinum and pneumopericardium without any findings of anastomotic leak or other pathology from the abdomen. A meticulous review of the literature was conducted about the pathophysiology, treatment options and outcomes of pneumomediastinum after a surgical procedure.

Discussion

This is the first study presenting the case of spontaneous pneumomediastinum with a synchronous pneumopericardium in the literature as a late complication of Whipple procedure. The applied diagnostic algorithm and conservative treatment are presented to extend our limited knowledge about this rare medical entity.

Conclusion

Awareness of these medical entities is important for the adequate management and optimal outcome of patients presenting a spontaneous pneumomediastinum. As such, all cases, treatment decisions and outcomes should be reported.